Sunday, November 29, 2015         


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Many women unaware of level of risk for breast cancer

By Terri Imada


October is Breast Cancer Awareness Month, and while we have made great strides in building awareness about this disease, there are still many women we have yet to reach.

At the Kapiolani Breast Center, in addition to offering mammograms and other medical services, we have the state's only High-Risk Breast Program.

While all women are at risk for breast cancer, some are at higher risk due to family history, genetic predisposition or previous pre-cancer diagnosis. For these women, Kapiolani's High-Risk Breast Program offers an intensive monitoring and prevention program to identify problems early and help patients take the steps to manage their risks.

Established in 2005, the program has seen more than 1,500 women statewide. I recently met with a Filipino woman in Hilo, and after conducting genetic testing, she was found to carry what is known as a BRCA1 gene mutation, which put her at a 60 percent to 80 percent risk of developing breast cancer and a more than 40 percent risk of developing ovarian cancer.

After additional testing and counseling, this patient opted for preventive surgery to remove her ovaries and uterus and is now considering a mastectomy, with breast reconstruction, for the same reason.

Other options include closer screening with more frequent clinical exams along with annual mammography and more sensitive magnetic resonance imaging (MRI).

This patient also has a sister living in Kona who tested positive for the gene mutation. She has not yet decided on her course of preventive treatment.

Circumstances that would qualify a woman for Kapiolani's High-Risk Breast Program include a close relative with breast cancer; a personal or family history of ovarian cancer; or diagnosis from a previous breast biopsy of a pre-cancerous condition known as atypical hyperplasia, which involves an accumulation of abnormal cells in a breast duct or gland.

Others are a diagnosis of lobular carcinoma in situ (an area of abnormal tissue growth that occurs within the milk glands located at the end of the breast ducts) on a previous breast biopsy; or a family history of male breast cancer.

Services provided by the High-Risk Breast Program include risk assessment, state-of-the-art breast imaging, genetic counseling and testing, clinical trial enrollment, education on risk reduction, prevention and early detection, and nutrition counseling.

Diet and nutrition play a big role in reducing the risk of breast cancer. Reducing one's body fat decreases the amount of excess estrogen, which contributes to breast cancer. Another benefit to staying fit is that your immune system will be healthy, and that can lead to greater protection from cancer.

Most of the program's services are covered by health insurance, but women who do not have insurance can access Kapiolani's High-Risk Breast Program.

Our services also are available on Maui, West and East Hawaii, Kauai and Molokai. Lanai residents can visit the Maui site. Call Kapiolani Health Connect at 527-2588.

Terri Imada is an advanced practice registered nurse and a certified adult nurse practitioner at Kapi'olani Breast Center. "Health Scene" is a monthly column by Hawaii healthcare professionals.

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