High-Risk Breast Clinic

The High-Risk Breast Clinic identifies and manages women who may have a significantly higher risk for developing breast cancer based on various factors. Such factors include increased mammographic density (BI-RADS C or D), atypical hyperplasia (ADH or ALH), lobular carcinoma in situ (LCIS), a strong family history of breast cancer, or a history of radiation therapy to the chest at an early age, among others. Discussion of options for screening (including supplemental imaging), risk reduction (preventive medications and lifestyle changes), and development of a breast care plan are generally part of the evaluation.

Breast Density

Mammographic facilities are now required to report out breast density for all women who receive a mammogram. This is important because with increasing levels of density, the chance of missing a cancer with routine mammography goes up. Also increased density is an independent risk factor for breast cancer. Density categories are rated according to the BI-RADS system as A, B, C, or D. The latter two are considered to be dense, and about fifty percent of women are in the dense category. We consider supplemental imaging for women with dense breasts which can include breast MRI, contrast enhanced mammography (CEM), or automated whole breast ultrasound (ABUS). There is much nuance about these decisions, and Dr. Smith enjoys considering these details with his patients.

Atypical Hyperplasia

Atypical hyperplasia (atypical ductal hyperplasia or ADH and atypical lobular hyperplasia or ALH) are two findings that are diagnosed generally on core needle biopsies for suspicious mammographic areas. They are felt to be markers of increased risk for breast cancer that give a woman 3-5 times the risk as compared to an average risk woman. Fortunately, we have good options for managing this risk, which is the purpose of the High-Risk Clinic. Dr. Smith helps develop a shared breast plan which organizes recommendations based on current national guidelines.