Customized Care for Breast Cancer Available

Cleveland Clinic’s Comprehensive Breast Cancer Program offers highly personalized care for women with this common malignancy in two specialty clinics.

Hereditary High-Risk Breast Cancer Clinic

The statistic is startling: 96 percent of individuals who carry a genetic mutation for breast cancer do not realize they are at risk.

The Hereditary High-Risk Breast Cancer Clinic wants to change that by working with primary care physicians to identify, monitor and counsel such patients sooner.

“If we don’t identify high-risk families early, we can’t reach the women ‒ or men ‒ who may benefit from a proactive approach,” says Holly Pederson, MD, Director of Medical Breast Services.

Family history, gender and heritage

It is crucial to expand the typical high-risk profile to include other key risk groups:

• Young women with a family history of early-onset, bilateral or male breast cancer, or ovarian cancer
• Men with a family history of early-onset, bilateral or male breast cancer or ovarian cancer (BRCA 2 mutations also increase their prostate cancer risk)
• Women and men of Ashkenazi Jewish heritage, even without a family history (1 in 40 carry BRCA gene mutations)

Not all patients develop breast changes

Dr. Pederson says high-risk patients should be evaluated even if they do not have breast changes such as a lump, pain or nipple discharge. If genetic testing reveals a mutation that raises their risk, they will be offered focused conversations on:

• Enhanced surveillance with breast MRI
• Chemoprevention with tamoxifen, raloxifene or aromatase inhibitors
• Risk-reducing mastectomy or oophorectomy
• Potential breast and prostate cancer screening for men

The Hereditary High-Risk Clinic’s genetic and breast specialists work closely with patients to develop a plan that integrates their wishes with their clinical profile.

In addition, men and women of childbearing age who know their carrier status may opt for preimplantation genetic diagnosis (PGD), utilizing in vitro fertilization to only implant embryos that don’t carry the gene mutation.

Even when the results of an evaluation in the clinic are negative, “that may be very reassuring to patients, who may still be candidates for enhanced surveillance or preventive medications,” says Dr. Pederson.

Young Women’s Breast Cancer Clinic

The new Young Women’s Breast Cancer Clinic coordinates the care and addresses the needs of newly diagnosed patients under age 50.

Breast cancer is relatively uncommon among women in their 20s, 30s and 40s but is more likely to be advanced, aggressive and caused by a genetic defect.

Young breast cancer patients may respond differently to treatment than older patients, and the disease impacts their lives differently. “Young women are juggling jobs, parenting and educational demands,” says oncologist Halle Moore, MD.

“They have complex diagnostic, therapeutic and support issues. A variety of treatment options are available. Timely consultations should help avoid treatment delays while still giving patients the time and information needed for individual decision-making.”

The clinic meets three times a week at our main campus to accelerate treatment, coordinate appointments and reduce return visits. It offers a broad array of services, including:

• Genetic counseling: A review of screening and testing options to detect BRCA1, BRCA2 and other gene mutations linked to increased breast cancer risk that may allow targeted treatment
• Dedicated breast imaging: Imaging by radiologists dedicated to breast diagnostics
• Fertility preservation: The latest preservation and assisted reproduction techniques, including ovarian cycling suppression during chemotherapy; oocyte, embryo and ovarian tissue harvesting and cryopreservation; and in vitro fertilization
• Advanced surgical options: Advanced conservation, reconstruction and lymphedema reduction techniques, including nipple-sparing mastectomy, as well as single-stage mastectomy and breast implant insertion
• Advanced plastic and reconstructive surgery options
• Radiation therapy
• Chemotherapy: Options include targeted and endocrine therapy tailored to young women
• Breast cancer clinical trials: Access to a wide array of trials, including hair loss prevention and other studies specifically impacting young patients
• Psychological support: Social work support, psychological and lifestyle counseling, and therapy geared to young breast cancer patients

“From diagnosis to treatment to survivorship, young women with breast cancer need this coordinated, comprehensive approach,” says Jame Abraham, MD, Director of Medical Oncology.

Adds Stephen Grobmyer, MD, Director of Surgical Oncology, “Young patients need advanced medical and surgical care, along with a support system of mental health professionals, social workers and peers who understand the issues they face.”

Dr. Abraham and Dr. Grobmyer co-direct the Comprehensive Breast Cancer Program.

To refer patients to Cleveland Clinic’s Hereditary High-Risk Clinic, call 216.444.3052 or 800.223.2273, ext. 43052.

To refer patients to the Young Women’s Breast Cancer Clinic, call 855.REFER.123.