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Caring for Women at High Risk of Breast Cancer

As part of National Breast Cancer Awareness Month, Look InsideKP is highlighting Kaiser Permanente’s end-to-end care — from early detection of breast cancer to treatment to survivorship.

For 25 years, Betsy Block lived in fear of getting breast cancer.

Her mother had breast cancer at age 30, and her aunt and grandmother had breast cancer too.

Since age 16, Block had kept a rigorous screening schedule of alternating mammograms and MRIs every six months. Then, three years ago at 40, Block had genetic testing and learned that she has a mutation in her BRCA2 gene  — putting her at increased risk for breast and ovarian cancers.

“Getting the test results was actually a weight lifted because it allowed me to take control and feel confident in making some decisions,” she said.

Only about 5 to 10 percent of breast and 17 percent of ovarian cancers are linked to inherited mutations in a BRCA gene. But a woman who has the BRCA gene mutation may have as high as an 85 percent lifetime risk of developing breast cancer, whereas an average woman’s lifetime risk is about 12 percent. She will also have a higher risk of ovarian cancer.

Block’s primary care physician referred her to the Kaiser Permanente Oakland Breast Care Center’s High Risk Clinic, which is led by Veronica Shim, MD. The service is dedicated to caring for women who are at high risk for breast cancer based on family history, genetic testing, or other factors.

“I was concerned that I wouldn’t have options, but my physicians sat down and listened to me and recommended a couple of different choices,” Block said. “They helped me wisely approach what can be an overwhelming amount of information so I could make an incredibly informed decision.”

Making a Difference in Risk Reduction and Survival

The Oakland clinic is one of six throughout Kaiser Permanente’s Northern California region that offers a range of coordinated services. At these centers, patients meet with an array of specialists, often on the same day, including a genetic counselor, oncologist, breast surgeon, plastic surgeon, and peer navigator.

Other Kaiser Permanente high-risk clinics are located in Fresno, San Francisco, Sacramento, San Jose, and Vallejo. High-risk patients are cared for at all Kaiser Permanente facilities and can be referred to a high-risk center by Kaiser Permanente Genetics or a primary care physician.

“Each center’s approach is to create individualized risk-reducing recommendations,” Dr. Shim explained. “We evaluate each woman’s cancer risk factors, help her understand how different factors can influence their risk, and we provide information and treatment to reduce her risk.”

Recommendations for reducing a woman’s risk of breast and ovarian cancer can include diet and exercise, risk-reducing medicines, and a breast cancer screening schedule with alternating MRI and mammography. Risk-reducing surgeries may include nipple-sparing mastectomy or removal of a woman’s ovaries and fallopian tubes, which not only decreases ovarian cancer risk, but also cuts a woman’s risk of breast cancer in half.

Bethan Powell, MD, is the medical director of Kaiser Permanente San Francisco’s Hereditary Cancer Risk Program. She said about 900 women across the region have been identified as having a BRCA mutation, and they benefit greatly from Kaiser Permanente’s integrated approach.

“We have the tools to implement some very specific strategies that can make a huge difference in risk reduction and survival,” Dr. Powell said. “It’s an incredible experience to help women change what was their destiny.”

‘I Felt Cared For’

A woman’s decision to pursue a specific strategy to reduce her risk of cancer is highly complex and deeply personal. Betsy Block’s decision was influenced by a number of factors including having an important role model in her mother, the tragic loss of a friend from breast cancer, and her own feeling that she would still feel feminine and happy in her body if she elected to have surgery.

She chose to have a risk-reducing double mastectomy with reconstruction, and surgery that removed her fallopian tubes but not her ovaries. She described the advice and care she received and continues to receive as thoughtful and personal.

“I feel like I got best-in-class care,” she said. “I don’t think I could’ve gotten better care anywhere in the country. And more important, I felt cared for.”

If you believe you may be at high risk for breast or ovarian cancer, talk with your primary care physician about your concerns. Your provider can review your cancer history and may refer you to a genetic counselor.


breast cancergenetics

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