High-Risk Breast Cancer Program

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Breast cancer is the most common type of cancer in the United States, other than skin cancer. While the rate of breast cancer has gone down in recent years, a woman's chance of getting breast cancer during her life is about 1 in 8, and her chance of dying from breast cancer is about 1 in 35.

Most breast cancer starts in the lobes in a woman's breasts that produce milk and the ducts that carry milk to the nipple. In women who have cancer, the growing mass of cells will form a lump. That's why women should perform regular breast self-exams to check for lumps. When it is found early, the five-year survival rate for women with breast cancer is 98 percent.

However, not all lumps in the breast are cancerous. Some may be fluid-filled cysts or caused by fibrosis, which is scar-like tissue. Such lumps are non-cancerous (benign), but may still cause swelling or pain.

There are many types of breast cancer, though some are very rare. Sometimes a breast tumor can be a combination of types. Among the most common:

Ductal carcinoma in situ (DCIS) – This is the most common type of non-invasive breast cancer. DCIS means that the cancer is only in the ducts and has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram.

Lobular carcinoma in situ (LCIS) – This condition begins in the milk-making glands but doesn't go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS follow the screening guidelines for breast cancer.

Invasive (infiltrating) ductal carcinoma (IDC) – This is the most common type of invasive breast cancer. It starts in a milk passage or duct, breaks through the wall of the duct and invades the tissue of the breast. From there it can spread to other parts of the body. It accounts for about 8 out of 10 invasive breast cancers.

Invasive (infiltrating) lobular carcinoma (ILC) – This cancer starts in the milk glands or lobules. It can spread to other parts of the body. About 1 out of 10 invasive breast cancers are of this type.

Inflammatory breast cancer (IBC) – This uncommon type of invasive breast cancer accounts for about 1 to 3 percent of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The breast may become larger, firmer, tender or itchy. IBC is often mistaken for an infection in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.

Men can get breast cancer, too. Until they reach puberty, the breast area in boys and girls develops in the same way. By the time boys reach their teens, however, hormones keep the breasts from developing. Like women, men have ducts and lobes in their breast area but in far smaller numbers.


Although we still do not know what causes cancer, there are new and powerful options available today to successfully detect and fight breast cancer. The most important factor is catching cancer early, when it is most treatable—or closely monitoring women who may be at increased risk. Even more important is the chance to prevent cancer in some women who are known to have the highest risk for breast cancer.

As a NCI-designated cancer center, UVA features comprehensive cancer detection and treatment options, as well as personal support for you and your family.

    What is Your Breast Cancer Risk?

    Jennifer Harvey, MD, discusses the various risks that may lead to a breast cancer diagnosis. View Transcript.

    Breast Cancer Risk Factors

    These are the risk factors for breast cancer:

    • Age — Risk increases with age, especially after age 50
    • Gender — Women are 100 times more likely to get breast cancer than men, but men can get it, too
    • Race — White, non-Hispanic women have the highest overall rate for breast cancer in the United States. African-American women who are ages 40 to 50 have a higher incidence than white women.
    • Personal history of cancer (this may be caused by both heredity and environmental factors)
    • Family history of breast cancer or ovarian cancer
    • Early onset of menstrual periods (before the age of 12)
    • No children or children born later in life
    • Use of (combined) hormone replacement therapy (estrogen and progesterone)
    • Alcohol use, especially excessive use
    • Overweight and lack of physical activity

    What You Should Know About BRCA1 and BRCA2

    The mutations that most often cause breast cancer are changes in the BRCA1 and BRCA2 genes ("Breast cancer 1 gene" and "Breast cancer 2 gene").

    Women with inherited mutations in the BRCA1 or BRCA2 genes are three to seven times more likely to develop breast cancer than those who do not have the mutations, and at an earlier age. There are also many other less common gene mutations that can cause breast cancer (for example, PTEN, p53, CDH, ATM, CHEK2 among others).

    According to the National Cancer Institute (NCI), the women who are mostly likely to have BRCA1 or BRCA2 mutations are those of Eastern European (Ashkenazi) Jewish heritage and/or those with family members who have had:

    • Multiple cases of breast cancer
    • Cases of both breast and ovarian cancer, or
    • One or more family members with two primary cancers (original tumors at different sites)

    However, the NCI also notes that not every woman in such families carries an alteration in BRCA1 or BRCA2, and not every cancer in such families is linked to alterations in these genes.

    For many women, an evaluation performed by the specialized providers at the UVA High-Risk Breast and Ovarian Cancer Clinic can provide valuable insight into increased cancer risk.  For women who are at higher risk for breast cancers, the high-risk program offers many options for potential genetic testing, cancer screening and risk-reduction options.

    Hereditary versus Sporadic Cancer

    We all have 20,000 to 25,000 genes in the cells of our body. These genes determine all of our characteristics—hair color, height, body type and so on. Cancer is caused by uncontrolled growth of cells as the result of mutations in genes.

    Hereditary Cancer

    Because the mutated genes that cause hereditary cancer are inherited from a person's parents, every cell in the body of a person with such a mutation contains the mutation.

    It usually takes more than one mutation to cause cancer, but people who inherit a cancer-causing mutation are that much more likely to get cancer in their lifetimes. For example, only about 5 to 10 percent of breast cancers are considered to be the result of inherited mutations.

    Sporadic Cancer

    About 90 percent of all cases of cancer are sporadic cancers. Unlike hereditary cancer, in which mutations are passed on from parents, in cases of sporadic cancer, the mutation occurs spontaneously—often from unknown origins and reasons.

    Doctors believe that these mutations are caused through exposure to risk factors for cancer during a person's lifetime.


    The following are the most common symptoms of breast cancer. However, each individual may experience symptoms differently. Early breast cancer usually doesn't cause pain and may cause no symptoms at all. And some breast cancers never cause symptoms or other indications of a problem.

    As the cancer grows, however, it can cause changes that women and men should watch for, such as:

    • A lump or thickening (a mass, swelling, skin irritation or distortion) in or near the breast or in the underarm area
    • A change in the size or shape of the breast
    • A change in the color or feel of the skin of the breast, areola or nipple (dimpled, puckered or scaly)
    • Nipple discharge, erosion, inversion (pointing inward) or tenderness


    At UVA, our diagnostics include today’s most sophisticated tools for the detection of even the smallest cancers. Should you need further treatment, UVA is one of the nation’s top cancer centers. Our team is ready to help you. 

    Among the tools we offer for both screening and diagnosis are the following:

    • Digital mammography uses computer-generated images to provide finer images than traditional mammography. Results are usually available within seconds.
    • Tomosynthesis, or 3D mammography, detects very small cancers that can’t be found with traditional mammograms. It also helps doctors rule out false positives, reducing the number of follow-up screenings.
    • Screening MRI is a sensitive imaging technique that can find breast cancers that mammograms might miss and can be offered to the highest risk women.
    • Ultrasound-guided biopsy uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass.
    • Stereotactic biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a three-dimensional (3D) picture of the breast.

    Treatment for High-Risk Women

    If your family or personal history shows a significant level of risk, our team will work with you to design a treatment plan that's right for you. We can offer several strategies to help keep you healthy while aggressively monitoring for the development of any cancer.

    These include:

    • Personal risk assessment and close observation with cancer screening
    • Chemoprevention, which offers FDA-approved medications, including tamoxifen and raloxifene, to help prevent breast cancer from developing
    • Surgical risk reduction options for those women who carry genetic mutations and have the most increased risk of developing breast cancer

    Genetic Counseling

    Genetic mutations and other inherited risk factors are a factor in less than 10 percent of all breast and ovarian cancers. There are multiple genetic mutations aside from BRCA mutations, if a woman does carry an inherited mutation, specifically the BRCA1 or BRCA2 gene, our genetic counselors can help you determine if you need genetic testing and whether it's covered by insurance. 

    Because genetic risk is complex, our genetic counselors are an integral part of the high-risk program’s interdisciplinary team, whose primary purpose is helping you manage your risk of developing cancer. 

    Prevention Options

    To reduce your risk of breast cancer, and to keep yourself healthy overall, you should eat a balanced diet, get regular exercise and try to keep yourself relaxed and stress-free. You should also avoid risk factors that are under your control and known to cause cancer.


    Chemoprevention is the use of natural or synthetic substances to reduce the risk of getting cancer or of having cancer recur. Chemoprevention works in several different ways. First, it can prevent the mutations that can cause cancer. It can also help stop the process that makes the mutated, damaged cells grow out of control.

    Chemoprevention is not the same as chemotherapy. Chemotherapy is used to kill cells that have already mutated and become cancerous. Chemoprevention is done to try to stop cells from becoming cancerous.

    Tamoxifen and Other Preventive Medications

    Doctors in our High-Risk Breast and Ovarian Cancer Program use two different chemopreventive drugs—tamoxifen and raloxifene. These are the only two chemopreventive drugs approved by U.S Food and Drug Administration for reducing the risk of breast cancer.

    Your doctor will work with you to help determine which chemopreventive agents might help lower your risk of cancer or help keep you from developing cancer.

    Surgical Risk Reduction

    UVA's High-Risk Breast and Ovarian Cancer Clinic may offer women at the highest risk of breast cancer surgical options to reduce their risk. This is primarily for women who carry a genetic mutation. By removing the breasts (performing a mastectomy) before any cancer develops, it can almost eliminate any risk of breast cancer.   

    If Breast Cancer is Diagnosed

    If you need treatment for a diagnosed breast cancer, UVA also provides comprehensive treatment with surgery, chemotherapy and radiation.

    Surgical Treatment

    Our breast care program is led by board-certified breast and plastic surgeons who specialize in both surgery and reconstruction for our breast cancer patients. We offer the full complement of innovative and minimally invasive surgery including:

    • Lumpectomy
    • Mastectomy
    • Breast reconstruction

    Chemotherapy or Hormonal Treatment 

    • Our board-certified breast oncologists specialize in the treatment of breast cancers. We offer the full complement of both standard treatment and clinical trials

    Radiation Treatment

    • Radiation therapy, using some of the most advanced radiation technology available anywhere and innovative clinical trials that sometimes allow breast radiation to be done more quickly