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Understanding your breast cancer risk

From the collective heritage shared by family members to the narratives woven within our genes, our bodies are a storybook of information. “Communication is an important preventive step,” explains Erica Case, nurse practitioner at Bass Breast Center, a department of Kalispell Regional Medical Center. “Having a conversation with relatives about the history of cancers in your family or talking with your primary care provider about that history and any health concerns can often be a lifesaving action.”

According to the American Cancer Society, in 2019, Montana had nearly 6,000 new cases of cancer with the leading majority of 890 cases being breast cancer in women. About 5 to 10 percent of cancers are considered to be hereditary and can be passed from parent to child, whether they are male or female. Hereditary breast cancer is most commonly associated with mutations in BRCA1 and BRCA2, which not only causes an increased risk for breast cancer but other cancers as well, such as ovarian, fallopian tube, and peritoneal, and smaller risks of prostate and pancreatic cancer. “We want to promote education about these life-saving medical services Kalispell Regional Healthcare has to offer, as well as increase access to these services for individuals all across Northwestern Montana, which is a sparsely populated region,” says Tiana Pallister, genetic counselor at Bass Breast Center. “If you have an extensive history of cancer in your family or family members who had cancer at a young age or any rare cancers, such as ovarian or pancreatic cancer, those are clues that are not only worth a discussion, but further investigation.”

In 2018, with the addition of Pallister to the team, Bass Breast Center began offering in-house genetic counseling and testing for patients who were considered high-risk. Genetic testing can offer invaluable health information to help identify health conditions and focus medical decisions. Results may affect cancer treatment methods, as well as encourage other relatives to look further into their own screenings and prevention. To increase action and awareness, initial genetic counseling consultations with Pallister are currently offered free of charge. “Genetics can give us significant insight to your personal risk of cancer and therefore appropriate health care plan,” Pallister explains. “If we know someone has a genetic predisposition to certain types of cancer, we can do something about it—such as perform more frequent screenings or provide more targeted treatments—and we can save lives.” 

The most common type of breast cancer is one that develops after menopause and is driven by female hormones, estrogen and progesterone. It is slow growing and very treatable when caught at an early stage. The average woman can have a 12-percent chance of developing breast cancer in her lifetime, while women with a hereditary gene mutation can have a heightened probability of up to 80 percent. A woman may be considered at a high-risk for breast cancer if she has an inherited disposition or one or more of the environmental risk factors. Sometimes, even without having a genetic mutation, some people may qualify for enhanced breast cancer surveillance based on their own family history and/or personal risk factors.

“With the high-risk population, most of the time it’s something you can distill for people,” says Case. “All of those questions you have to fill out for yearly exams with your primary care physician or gynecologist about your personal health history are significant indicators of a person’s risk as well. Once we are referred or identify a high-risk individual, we can give them a number for where they are in terms of their current cancer risk. That is comforting for most patients because it’s something they can hold on to and understand where their risk falls. It helps them, and us, understand how we should move forward and what proactive steps can be taken.”

Case and Pallister believe it’s never too early to take preventive steps toward your breast health. Even everyday choices can help women avoid an increased risk of breast cancer and other types of cancers. Shifting to a healthier lifestyle—including limiting alcohol intake, eating little to no animal fats, and maintaining a healthy body weight—can decrease risk by up to 30 percent. Today, with early diagnosis and new treatments, breast cancer is no longer a death sentence. “Over the years we’ve become so good at treating it that even women with metastatic breast cancer are living with the disease for years,” Case says.

Access to care can also be a consideration for a woman’s risk. In 2008, Kalispell Regional Healthcare introduced the Winkley Women’s Center, a mobile mammography unit, with the goal of providing mammograms to those in rural communities. The mobile coach was named for local resident, philanthropist, and breast cancer survivor Jane Winkley, whose generosity made the coach possible. During its eleven year tenure, the Winkley Women’s Center racked up 2,800 miles a month serving women from Eureka down to Polson, and multiple other communities along the Hi-Line as far as Malta. Countless women received regular checkups thanks to the Winkley coach and, as a result, many cases of breast cancer were detected early enough to treat quickly. In just over a decade, more than 21,000 screenings were performed aboard the coach and 160 cancers were detected.

Every women screened with mammography on the Winkley coach is also asked a detailed history to screen her for her risk of a genetic mutation as well—those found to have a potentially higher than average risk, are referred to Case and Pallister. This program is made possible through the Save a Sister initiative and a grant from Halt Cancer at X. The Kalispell Regional Healthcare Foundation is currently working on raising funds to purchase a new coach and outfit it with updated imaging technology to maintain this community service. “We want to be a resource for the community and help Montana’s women stay informed so they can make the best decisions about their personal health,” says Pallister.

The Bass Breast Center honed their services and treatment programs to provide the women of Montana comprehensive care for malignant and premalignant conditions of the breast. With a dedicated breast surgeon, nurse practitioner, genetic counselor, and nurse navigators, the team works very closely with the imaging department, oncologists, and radiologists to offer patients a collaborative, streamlined treatment process. “We know there are a lot of moving parts,” Case adds, “but part of our goal is to keep everyone on the same page to make this experience as smooth and positive for our patients as possible.”

To learn more about breast health services at Kalispell Regional Healthcare visit www.KRH.org/BreastHealth.

Written By Dena Tomlinson

This article was originally published in the October 2019 issue of 406 Woman.