Personalized Breast Cancer Risk Assessment Equals Peace of Mind

Breast surgical oncologist Jennifer Plichta, MD, counsels Shanel Wilson-Poe on her breast cancer risk.Breast surgical oncologist Jennifer Plichta, MD, counsels Shanel Wilson-Poe on her breast cancer risk.Shanel Wilson-Poe, 43, knows that one-in-eight women in the U.S. will develop invasive breast cancer in their lifetime and she doesn’t want to be one of them. So, when her annual mammogram — her first ever mammogram — and a biopsy back home revealed abnormalities, she was concerned.

Following the advice of friend, she came to Duke for a second opinion. An excisional biopsy to remove suspicious breast calcifications revealed atypical hyperplasia, a collection of abnormal cells considered a marker for an increased risk of developing breast cancer.   

Her surgeon Shelley Hwang, MD, MPH, chief of breast surgery at Duke Cancer Institute, referred her to the Duke Breast Risk Assessment Clinic (BRAC). There, director of the clinic Jennifer Plichta, MD, MS, performed an in-depth breast cancer risk assessment and designed a personalized breast care plan to manage and potentially reduce Wilson-Poe’s breast cancer risk.

Launched under Plichta’s leadership last summer, the guiding philosophy of the clinic is that patients with an elevated risk for breast cancer may benefit from greater observation, more advanced screening and/or therapeutic intervention.

Plichta and her team of skilled clinicians are employing scientific analysis and cutting-edge technology to do what they can to prevent women like Wilson-Poe from getting breast cancer, and if they do get cancer, help catch it early.

Patients at increased risk include those who may have specific genetic mutations; a family history of breast cancer; a diagnosis of atypia, like Wilson-Poe, or lobular carcinoma in situ; dense breasts on mammography; or other individual risk factors, including therapeutic radiation at a young age or prolonged hormone therapy use.

“Women at increased risk for breast cancer should know they have options beyond regular mammograms,” explained Plichta, who’s also an assistant professor of surgery and a surgical oncologist with Duke Health. “The comprehensive risk assessment our team of skilled clinicians provide is a critical first step in determining their level of risk and the right prevention plan.”

Some women may require more frequent or special breast imaging, such as breast MRIs or 3D mammograms, while others may benefit from preventative medication or risk-reducing surgery. Some may also be candidates for molecular genetic testing at Duke Cancer Institute’s Hereditary Cancer Clinic.

For now, Wilson-Poe, who has no family history of breast cancer, has elected to continue with bi-annual clinical breast exams and 3D mammograms.

She said she appreciates that her doctors at Duke — from surgery through risk assessment — gave her different options, advised what would be best, and ultimately emphasized that her treatment plan was her decision.

“I feel very protective of my body and I just felt very comfortable with them; that I was in good hands — safe,” said Wilson-Poe, a brow studio owner in the Greensboro, North Carolina area, who travels an hour to Duke for her appointments. “It was so worth it for me to come to Duke where my care has been the very best.”

More than 40,000 women die from breast cancer each year. However, mortality is declining due to the kinds of early detection interventions and improved treatment options delivered at innovative cancer centers like Duke.

Nationally renowned breast cancer surgeon Shelley Hwang, MD, MPH, who’s played a key role in the evolution of the Breast Risk Assessment Clinic, stressed that “when it comes to treating cancer, prevention is first and foremost.”

“I can picture a day when this level of cancer risk assessment is part of routine adult oncology care,” she said.  

The Breast Risk Assessment Clinic operates on Thursdays in Clinic 2-2 of the Duke Cancer Center. Patients may be referred to the clinic or self-refer. The clinic supplements its risk assessment services with monthly breast wellness education sessions focusing on such topics as genetic testing, breast imaging, breast self-exam techniques, family history, cancer prevention, research, and community.