Clinic Helps Women
Guard Against Breast Cancer
Julie Griffie, RN, MSN, CS, AOCN
Froedtert & the Medical College of Wisconsin Clinical Nurse Specialist; Breast Cancer Program
Any woman can develop breast cancer, but some are at greater risk than others. Julie Griffie, RN, talks about how Froedtert & the Medical College of Wisconsin can help women determine their risk level and take steps to protect themselves.
Q. What is the Froedtert & the Medical College Breast Cancer High Risk Assessment Clinic?
The Breast Cancer High Risk Assessment Clinic offers an opportunity for women to assess their personal risk, get strategies for addressing modifiable risk factors and develop individualized plans for breast cancer surveillance.
Q. How did the clinic get started?
We originally put this clinic together with our breast cancer patients in mind. As patients would finish treatment, they often asked us, "What about my daughter? What about my mother and my sisters? What should they be doing?"
Q. Who is most at risk for breast cancer?
Every woman is at risk for breast cancer, but some are at a greater risk because of known risk factors – things like early menses and late childbearing.
Anyone who believes they are at higher risk – for whatever reason – is welcome at the Breast Cancer High Risk Assessment Clinic. If you want to make sure you're following a lifestyle that decreases your risk as much as possible, or if you have questions about your own personal surveillance program, we'd be happy to have you come through.
Q. What can women expect when they visit the clinic?
Before you visit, we ask you to provide information. We ask you to detail your family history, provide us with personal health history information, and keep a diet diary for three days. Our team – a nurse practitioner, a dietitian and a genetic counselor – reviews your information. We then come up with a plan for your visit.
The typical clinic session lasts about two and a half hours and there is normally just one session. Everybody sees our advanced practice nurse and dietitian. You may also see our genetics counselor if your history indicates this is appropriate, or you are simply interested in doing so.
If you are over the age of 40 and have been getting mammograms, we have you bring your mammograms with you so we can review them with our staff radiologist. About half of the time, we actually have the patient imaged while she is here just to check on some things.
Based on all our information, we give the patient a number of recommendations. After the session, we review everything with Dr. Walker (Alonzo Walker, MD, Medical College of Wisconsin surgical oncologist and director of the Froedtert & the Medical College of Wisconsin Breast Cancer Program). Finally, the patient receives a letter summarizing what has happened and what our recommendations were. The letter is also mailed to the patient's primary care doctor.
And that's it. We hope women will take our recommendations, go back to their primary care doctors and make lifestyle changes if they are appropriate.
Q. What kind of recommendations do you typically make?
We encourage women to do breast self-exams. Our nurse practitioner helps them understand what's normal for their breasts and for their body.
We also make a recommendation about how often they should have clinical breast exams. Based on the patient's imaging studies, we also may recommend further tests, such as ultrasound or MRI.
For most women, surveillance includes three pieces – doing routine breast self-examinations, getting a clinical exam at least once a year and mammography.
Other routine recommendations cover diet and exercise. In addition, we spend a lot of time with smokers, talking about programs available to help them quit. For women who are post-menopausal, we discuss osteoporosis, because of the estrogen link. And we talk to women about the broader picture of cancer – Pap smears, colonoscopies for women over 50, and other routine screenings.
Q. Are there any other breast cancer surveillance tools?
We offer ductal cell lavage—a process in which you wash the milk ducts of the breast and aspirate the secretions to see whether you can find any precancerous or cancerous cells before they settle in and become a tumor.
Ductal cell lavage is time-consuming. You could never do it for large volumes of women. But for women who know they are at high risk, for instance a woman whose mom died from breast cancer and who has sisters who have been diagnosed, it may be a more sensitive tool than mammography.
Q. How does genetic counseling fit in?
Before your session, our genetic counselor determines whether the family history information you provide shows a possible genetic link to breast cancer.
We talk to patients about whether they are really interested in genetic counseling and possibly genetic testing. Some women are not. They may be at very high risk for carrying one of the genes, but they don't want to know because it's not going to change anything they are willing to do right now.
We never counsel someone about genetics and test them the same day. We want women to go home and think about it because it can have a big impact.
Q. Can high-risk women take any medications to prevent breast cancer?
We evaluate women for use of tamoxifen. Tamoxifen is an oral agent, a pill you take once a day. It has an anti-estrogen effect on cancer cells that are sensitive to estrogen—it keeps those cells from flourishing. Researchers have now found that it also helps prevent breast cancer.
You don’t want to give tamoxifen to everybody, because the drug has its own risks too. We give recommendations and provide education about its use and refer patients to a medical oncologist.