Gauging Risk

Duke helps women understand their individual risk of breast cancer

JENNIFER PLICHTA (right) with AMANDA HUDSON, who has battled breast cancer and receives services from the Breast Risk Assessment Clinic that Plichta leads. (photo by Colin Huth)JENNIFER PLICHTA (right) with AMANDA HUDSON, who has battled breast cancer and receives services from the Breast Risk Assessment Clinic that Plichta leads. (photo by Colin Huth)BREAST CANCER RISK EXISTS FOR ALL WOMEN. Led by breast surgeon and Assistant Professor of Surgery Jennifer Plichta, MD, MS, Duke’s Breast Risk Assessment Clinic helps women learn about their individual likelihood for developing the disease. Any woman can participate to determine her risk level, but the services mainly target women with a family history, genetic mutation, or an abnormal breast biopsy.

In addition to individual meetings with Plichta or one of her colleagues, high-risk women can attend group meetings where they learn about nutrition, exercise, breast imaging, genetic testing, and more. The group leader, nurse practitioner Kathy Trotter, DNP, FAANP, may even pass around breast models with lumps so women can learn to quickly identify possible future tumors. 

“These group meetings give women an opportunity to relate to each other on levels other than medical,” Plichta says. “They’re going through similar situations and face the same anxieties, risks, and decision-making about prevention and screening.”

The clinic also offers educational opportunities, including a free, day-long “What’s Best for Breasts” event, including information about screening, prevention, and treatment options. 

In 2017, a quarterly lecture series, open to the community, offered free sessions about breast imaging, diagnosis, surgery, and sexual health. Additional sessions are scheduled for 2018.

While the clinic gives patients access to breast specialists, it offers the same benefit to Duke’s primary care and gynecology providers, Plichta says.

“Breast cancer is an ever-changing field, and primary care providers are responsible for so many things, including diabetes, thyroid problems, managing blood pressure, and controlling chronic conditions,” she says. “They do a great job of reminding women to get mammograms, but it’s our job in the clinic to stay up on the latest with breast cancer.”

The Screening Question  

An important aspect of breast cancer screening is for women to know their own bodies, including how their breasts normally look and feel, Plichta says.

“If you notice a change in your breasts, discuss it with your care provider,” she says.

When it comes to formal screening, guidance has been murky for years. However, according to Jay Baker, MD, professor of radiology, recommendations now encourage some women to begin breast cancer screening earlier than ever.

Baker shares the following guidance that he gives to women who come to Duke radiology clinics:
● All women should begin annual screenings at age 40. 
● African-American women, who often face increased breast cancer risk, should consider risk assessment at age 30.
● Breast screening should continue if the woman is expected to live an additional 10 years.

Radiologists also now have a more sensitive tool, covered without copay by most insurance providers, available to screen women for breast cancer—mammograms with 3D tomosynthesis.

“This technology offers a 20-40 percent improvement in identifying breast cancers earlier and more accurately with fewer false alarms,” Baker says. “It also results in 15-30 percent fewer unnecessary recalls for additional image of false alarms.”

Learn More

Lars GrimmMachine Learning By Whitney J. Palmer 
For women with ductal carcinoma in situ, a form of low-risk breast cancer, Duke researchers are working to use “machine learning” to reduce unnecessary follow-up breast imaging and offer some women less-invasive treatment optionsRead

These articles appeared in the Fall 2018 issue of Breakthroughs, a magazine produced twice yearly by Duke Cancer Institute Office of Development. Subscribe to Breakthroughs