Download INN High Risk Breast Clinic

PROFILE
Dr. Maggie DiNome will oversee the
new High-Risk Clinic. Below, Veronica Vera,
a cancer patient, and husband, Vince on
their wedding day.
they need to reduce their risk and
get the appropriate screening,”
explains Dr. DiNome.
Preventive measures can lower
the risk of breast cancer in many
women. While some women
will still develop the disease,
enrollment in a high-risk clinic
should improve the odds that
any cancers will be detected early,
when the disease is most curable.
Preventive strategies can be as
simple as adhering to a healthy
diet and exercise regimen to the
decision to undergo prophylactic
mastectomy. The clinic will have
a nutritionist, nurse navigator
and genetic counselor available to
assist patients.
Anyone will be able to come
to the clinic for an assessment of
breast cancer risk. Those with a
family history of cancer or other
risk factors that increase their
risk, such as women who carry
the BRCA1 or BRCA2 gene
mutations, will have the full array
of resources available to them.
“It’s not only for patients who
are BRCA-positive but also
for those who have high risk
based on other risk factors,” Dr.
DiNome explains.
There are many risk factors to
material. When either of these
genes is mutated, or altered,
so that its protein product is
not made or does not function
correctly, DNA damage may not
be repaired properly. As a result,
cells are more likely to develop
additional genetic alterations that
can lead to cancer.
Inherited mutations in
BRCA1 and BRCA2 increase the
risk of female breast and ovarian
cancers and account for about
20% to 25% of hereditary breast
cancers and about 5% to 10% of
all breast cancers.
Veronica Vera wishes she’d had
access to a high-risk clinic earlier
in life. In 2011, the Los Angeles
woman was 33 and had been
married to husband Vince only
three weeks when she learned she
had breast cancer and carried the
BRCA1 gene mutation.
“I had never heard of the
BRCA gene,” Vera says. “Now,
after Angelina Jolie announced
she has it, more people realize
how important it is to get tested.
But when I was younger, no
one really knew about it. Even
today, few young people test for
it. Cancer runs in my family, so
I certainly would have benefited
The High-Risk Clinic is a new addition that
will help us to identify those patients at significantly
increased risk for breast cancer, either based on
family history or personal history, and provide them
the appropriate tools and resources they need.”
Beating the Odds
Prevention and screening
measures are game-changers
for women at high risk of
breast cancer
WRITTEN BY LAURA ROE STEVENS
22 INNOVATIONS, FALL 2013
Already a leader in breast cancer treatment, the Margie Petersen Breast Center
at Saint John’s Health Center will open a new clinic this fall aimed at serving
patients with the greatest odds of developing the disease. The clinic is a natural
step in the John Wayne Cancer Institute’s goal of providing personalized care
by thoroughly assessing individual risk, says Maggie DiNome, MD, the clinic’s
director and associate director of the Margie Petersen Breast Center.
“The High-Risk Clinic is a new addition that will help us to identify those
patients at significantly increased risk for breast cancer, either based on family
history or personal history, and provide them the appropriate tools and resources
assess, but due to the aggressive
nature of BRCA-related cancers—
which can develop at earlier
ages—it’s important to identify
those with inherited mutations as
soon as possible, she says.
BRCA1 and BRCA2 are genes
that produce tumor suppressor
proteins, which help repair
damaged DNA and play a role
in the stability of a cell’s genetic
from a high-risk clinic earlier
in life.”
Vera had no time to settle
into married life before
undergoing a double mastectomy,
reconstructive surgery, in vitro
fertilization and chemotherapy.
The couple chose to have IVF
and to freeze embryos before
cancer treatment in case the
treatments caused sterility or
ARE YOU AT RISK?
One in eight women develop breast cancer at some point in life.
However, certain risk factors increase those odds, including:
 Being younger when you first had your menstrual period
 Starting menopause at a later age
 Being older at the birth of your first child
 Never giving birth
 Long-term use of hormone-replacement therapy
 Getting older
 P ersonal history of breast cancer or some non-cancerous
breast diseases
 Family history of breast cancer
 Mantle chest wall radiation as teenager or young adult
 Dense breasts by mammogram
 B eing overweight (increases risk for breast cancer after
menopause)
H
aving changes in the breast cancer-related genes BRCA1
or BRCA2
 Not getting regular exercise
there were reproductive health
problems later on. However, the
couple conceived naturally and is
expecting a baby early next year.
“It’s a happy ending to the
beginning of a bumpy story,” Vera
says. “Our first year was spent
with surgery, complications,
reconstruction, IVF, chemo—
phew! It’s a miracle that I’m now
pregnant. I’m so thankful to Dr.
DiNome and all the physicians
who worked with me.”
While her life has returned
to normal, Vera says she will
remain vigilant to reduce her
risk of a cancer recurrence. Being
BRCA-positive means she is still
at higher-than-normal risk for
ovarian and reproductive cancers.
She will adhere to a schedule of
prevention checkups and will
likely undergo future salpingooophorectomies. Prophylactic
removal of the ovaries and
fallopian tubes lowers the risk of
ovarian cancer.
This past Labor Day, Vera
enjoyed a day at the beach and
reflected on the “wonderful” care
she received from Dr. DiNome
and the confidence she has placed
in her healthcare team. The future
is bright.
The High-Risk Clinic is part of the Margie Petersen Breast
Center at Saint John’s Health Center. Considered one of
the nation’s top facilities, the Breast Center provides a
comprehensive approach to diagnosing and treating breast
disease with state-of-the-art diagnostic and therapeutic
technology. The Breast Center offers the latest in breast
cancer screening, diagnosis and treatment. By providing
multidisciplinary care to patients with breast disease, women
are assured of receiving the most advanced treatment.
FALL 2013, INNOVATIONS
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