Presbyterian Hospital of Dallas Kicks Off Program to Track Women at High-Risk for Breast Cancer
10/13/2008

DALLAS — Elizabeth Krause is a perfectly healthy 40-year-old Dallas woman. So it may be surprising to learn she has oncologists, breast surgeons, radiologists and nurse practitioners watching over her like an army of cancer-killers, ready to pounce at the first sign of cancer.

But a new Breast Cancer Risk Assessment Service at Presbyterian Hospital of Dallas identified Krause as being at “high risk” for breast cancer because she carries a mutation of the BRCA gene, which predisposes her to the disease. She also has a family history of breast cancer.

“So many doctors appointments remind me of the thing that frightens me most,” she said, “but so many doctors appointments might just keep that thing — breast cancer — at bay forever. Or it may save my life if the disease ever does show up.”

The Breast Cancer Risk Assessment Service at Presbyterian, designed to identify and track women such as Krause who are at higher-than-average risk, is modeled after similar programs at M.D. Anderson Cancer Center in Houston and Harvard Medical Center in Boston, Mass.

As part of the program, which starts this week, every woman who comes through Presbyterian’s Women’s Diagnostic and Breast Center for a routine mammogram will be offered use of a laptop computer to take an electronic test that helps to determine her risk of developing breast cancer.

Those identified at high-risk will be offered the opportunity to enroll in the high-risk surveillance program, which offers genetic testing, breast MRI, 3D mammography, and consultations with physicians on the medical staff at Presbyterian Hospital of Dallas.

Kandice Kilbride, M.D., and Daphne McDonald, W.H.N.P., B.C.

Kandice Kilbride, M.D.,
and Daphne McDonald, W.H.N.P., B.C.

Click photo to download hi-res image
 

The computer system also automatically prints a letter to be sent to the woman’s primary care physician and OB/GYN, informing them of their patient’s breast-cancer risk. Women in the program will then be given a computerized questionnaire of all risk factors to determine their “breast cancer pedigree.”

“Without this assessment, many of these women would be going about their normal lives not realizing they were at higher-than-normal risk for the disease,” said Daphne McDonald, W.H.N.P., B.C., director of Presbyterian’s Breast Cancer Risk Assessment Service. “While all women are at risk for breast cancer and should perform regular breast self exams and follow other standard screening guidelines, women at high-risk need additional surveillance and education tools to help prevent the disease or diagnose it early when it does occur.”

An education component to the program will teach high-risk women how to do self breast exams, and educate them about how diet and exercise can lower their risk.

Women who carry the BRCA gene mutation, which gives them an 87 percent risk of getting breast cancer, will automatically be given a breast MRI. A positive test for this familial gene also will prompt the computer system to generate a letter that the woman, if she chooses, can send directly to first-degree relatives, who also may carry the gene mutation.

Lee Bourland is medical director of Presbyterian’s Breast Care Program.

Lee Bourland, M.D.

Click photo to download hi-res image

“We know that screening for breast cancer reduces mortality,” said Dr. W. Lee Bourland, a breast surgeon on the medical staff at Presbyterian Hospital of Dallas and medical director of Presbyterian’s Breast Care Program. “Our breast cancer risk assessment service first identifies the women with extraordinary risk and, second, assures that they receive the benefit of appropriate and regular screening. Women without identifiable extraordinary risk for breast cancer will benefit from our careful analysis and re-assurance.”

All women in the program will be given clinical breast exams between annual mammograms and between annual exams by their OB/GYNs. If any changes in the breast tissue are detected, clinicians then quickly determine the next move, whether it’s getting MRI images of the breast, additional mammography or administering an ultrasound test.

“This is a program designed to follow women from their 20s into maturity,” Bourland said. “In addition to the technologies and clinicians that each woman in the program will work with, this is also about education and empowerment: we want to teach women about breast self exams and how diet and exercise and other lifestyle factors can affect their risk of developing breast cancer.”

Some women at especially high-risk, including those who carry the BRCA gene mutation, may chose to reduce their risk through preventive surgery (called prophylactic mastectomy) or medical options, including the use of chemotherapies that may reduce their risk of developing breast cancer.

“Learning about their risk factors for breast cancer shouldn’t be something that’s scary for women,” said Dr. Kandice Kilbride, an oncology breast surgeon on the medical staff at Presbyterian Hospital of Dallas. “The reality is that we’re all at risk; denial doesn’t make the cancer risk go away. This program simply measures what level of risk and gives women the tools to address those risks.”

Several factors can contribute to a woman’s risk for breast cancer. Factors that place a woman at high-risk include: a family or personal history of breast cancer, history of ovarian cancer, an abnormal breast biopsy, or presence of the BRCA gene mutation.

Longtime Presbyterian Hospital of Dallas supporter Ellen Feldman Elliott made a $25,000 contribution to help purchase the laptops for the computer questionnaires. Over the years, Presbyterian supporters Helen and Bob Schmidt have contributed more than $180,000 to the breast care program.

The breast cancer risk-assessment survey given to women at Presbyterian’s Diagnostic and Breast Center is available to the public. For more information, call Daphne McDonald at 214-345-7374.

Services for women at high risk for breast cancer are also available at Harris Methodist Fort Worth Hospital. For more information, contact Gayle Wilkins, M.S.N.(c), R.N., O.C.N., at 817-820-4868.

Note to editors: Follow this link for a high resolution photo of Daphne McDonald and Dr. Kandice Kilbride.

About Presbyterian Hospital of Dallas
Established in 1966, PHD is the flagship hospital of Presbyterian Healthcare System, a member of the faith-based, nonprofit Texas Health Resources system. US News and World Report ranks PHD, a recognized clinical program leader, providing technologically advanced care to patients, among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. The 866-bed facility has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information about PHD, visit www.PHSCare.org.

About Texas Health Resources
Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served. The THR system includes 13 affiliated hospitals and a medical research organization, and THR is a corporate member or partner in six additional hospitals and surgery centers. THR’s family of hospitals includes Harris Methodist Hospitals, Arlington Memorial Hospital and Presbyterian Healthcare System. For more information about Texas Health Resources, visit www.texashealth.org.