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High Risk Clinic

Part of the Hereditary Cancer Program, the clinic provides follow-up for eligible adults whose genetic test results or those of their family indicate a high risk of developing certain cancers.

Referrals to the High Risk Clinic are given by genetic counsellors at the Hereditary Cancer Program. You can refer your patient to the Hereditary Cancer Program or they can refer themselves. 

Learn more about the High Risk Clinic services and what your patient can expect. 

Frequently asked questions 

 
People with breasts and a mutation in BRCA1, BRCA2, ATM, CHEK2, CDH1, PALB2, PTEN, STK11, TP53, or other gene associated with greater than 25% increased lifetime risk of breast cancer.

People with Li Fraumeni syndrome (TP53), a syndrome associated with an increased risk of many different cancers. 

People with breasts between ages 30 to 50 with Neurofibromatosis 1 because of increased breast cancer risk. 

 

If your patient is not eligible for the High Risk Clinic but has a risk of hereditary cancer, a care plan will be given to them and you, their care provider, by the clinical team at the Hereditary Cancer Program.

 
As the primary care provider, you are still the patient’s first point of contact for any new health concerns of any type. For example, if a breast lump is found by the patient, we ask that they see you for a physical examination and that you order the appropriate initial imaging. Please copy us on these results. We are happy to answer any questions you might have about what should be ordered.

For patients who live outside of the lower mainland, we also ask that you see them for annual clinical breast examinations if these are needed as part of their care. 

You may be asked to arrange local referrals or some screening investigations. We will communicate this to you in our clinic notes and you will receive copies of our notes each time we see your patient. ‎

 
After a patient has bilateral mastectomies, they are discharged from follow up in the high risk clinic. If prophylactic salpingo-oophorectomies have been recommended and not yet done, we will include the recommendation for referring the patient for this surgery at the current age guidelines.  

Patients who have undergone pre-menopausal oophorectomies are at increased risk of consequences of premature surgical menopause including early cardiovascular disease and secondary osteoporosis.  We ask that you follow them to screen and control other risk factors for CVD such as diabetes, hypertension and dyslipidemia. They should be encouraged to participate in weight bearing exercise and consume adequate dietary calcium and vitamin D. Bone density screening should be considered especially if there are other risk factors for osteoporosis. 

 

If they do not have a personal history of breast cancer and do not have breast implants, mutation carriers can have annual screening mammograms through the BC Breast Screening Program rather than routine diagnostic mammography. Patients under the age of 40 require a referral from a provider indicating their mutation. They will then be on annual recall.

 
  • Breast screening can continue during pregnancy with diagnostic mammography and breast US. Shielding from radiation is not required as the radiation dose is negligible with digital mammography. MRI with contrast is contraindicated.
  • Breast screening during lactation can be done with diagnostic mammography and breast MRI. Breast milk does not need to be discarded after an MRI. Diagnostic mammograms must be ordered.
  • Ideally, patients should nurse or pump to empty their breast prior to any of the above imaging, for comfort and accuracy of results.

 
The High Risk Clinic will order mammograms, MRIs and other recommended screening as needed. You may be asked to arrange non-breast related imaging and referrals for your patients. 

If you have already been ordering screening (such as annual mammograms following a breast cancer diagnosis), these can continue. The High Risk Clinic will order any additional screening (such as breast MRIs).

 
The High Risk Clinic will arrange specialist consultation referrals for screening or surgery (gastroenterology, dermatology, etc).

You may make referrals before your patient's first visit to the High Risk Clinic. This is particularly helpful if there will be a delay before your patient is seen or if your patient has previously been seen by a specialist in their own community (eg previous breast cancer surgery or previous gynecologic surgery). 


‎Oral contraceptives are not contraindicated in mutation carriers unless they have a personal history of breast cancer. The use of oral contraceptives for 5 years is beneficial due to a 50% reduction in the risk of ovarian cancer. 


There may, however, be a relative increased risk of early onset breast cancer in mutation carriers who take oral contraceptives for more than 5 years. Consideration should be given to non-hormonal contraception.

 

Hormone replacement therapy is recommended for women up to age 50 who have had premenopausal prophylactic salpingo-oophorectomies to mitigate against the long term consequences of premature surgical menopause. Therapy should be administered at doses necessary to minimize menopausal symptoms.

 

Following mastectomy with any kind of reconstruction patients do not require screening mammograms or MRIs. They should have an annual clinical examination of the reconstructed breasts. Any new masses should be investigated, initially with ultrasound and diagnostic mammography. 

 

 

Prophylactic salpingo-oophorectomies can be performed by a community gynecologist. The tissue removed must be processed pathologically according to the SEE-FIM protocol. 


Patients who have ovarian/fallopian tube malignant or premalignant lesions identified on this pathology should be referred to a gynecologic oncologist for consultation.

 

While there is evidence that ‘ovarian’ cancer begins in the fallopian tube, we do not yet know how effective salpingectomy alone is for risk reduction. Bilateral salpingo-oophorectomy is still the recommended procedure for ovarian cancer risk reduction. 

 

 

Find more information about hereditary cancer syndromes. 

 

 

Annual mammograms can be considered for those who also have gynecomastia beginning at age 50 or 10 years before the earliest male breast cancer in the family.

 
  • It is recommended that transfeminine females have been on 5 or more years of hormones at any time should have the same screening as high-risk women (annual mammogram and MRI).
  • It is recommended that transmasculine people who have not had bilateral mastectomies should have the same screening (annual mammogram and MRI) as high-risk women, including the recommendations above if they apply in pregnancy/lactation.
 
 

Our team

  • Dr. Rona Cheifetz, Medical Lead
  • Mr. Marco Gnoato, NP
  • Amandip Uppal, NP
  • Rebecca Morash, RN, Cancer Care Coordinator / Nurse Navigator
  • Clerk
Page last reviewed January 2023.
SOURCE: High Risk Clinic ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

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