Previvorship: How to Beat Cancer Before It Happens

Science has enabled physicians to predict the likelihood of a woman getting breast cancer, much in the same way that meteorologists determine where and when a tornado will touch down and Amazon ensures you receive your order quickly. Predictive modeling, when coupled with powerful tools such as genetic testing, helps doctors prevent breast cancer or detect it early when it is most curable.

Miami Cancer Institute physicians are at the forefront of these data-driven advances, working to prevent cancer as much as they are focused on curing it. Recently the Institute opened the Breast Cancer Prevention Clinic specifically for those with a genetic predisposition to breast cancer or another underlying issue that makes them more susceptible. This concept of previvorship promotes fighting breast cancer before ever getting it.

“In this clinic we will tailor a prevention plan for these patients,” said Jane Mendez, M.D., chief of breast surgery at Miami Cancer Institute, “so that instead of becoming a breast cancer survivor, they can continue as a previvor. Meaning that even though you have the increased predisposition to breast cancer, we keep it at that.”

With Breast Cancer Awareness Month in October, Dr. Mendez, sat down with Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute, for a recent episode of the Baptist HealthTalk podcast, Breast Cancer: Risks, Prevention and ‘Previvors.’ They discussed the latest breast cancer advances, as well as the basics such as screening guidelines and prevention recommendations.

Below are edited excerpts from their conversation. You can also access this and other Baptist HealthTalk podcast episodes in their entirety on your computer or smartphone or via Apple Podcasts and Google Podcasts.

Dr. Fialkow:

“Let’s start out by talking about what would be risk factors that would make a woman more likely to get breast cancer? What are the things we’ve identified that we want to pay attention to?”

Dr. Mendez:

“The two main risk factors for breast cancer are being a woman and getting older. So, even though we’d like to forget about breast cancer the older we get, the more concerned we need to be about it. To that, you can add other factors such as family history as well as some environmental factors, some hormonal factors, and some of those are modifiable and some are not.”

Dr. Fialkow:

“What would the average person be told to do regarding screenings, mammograms, etc.?”

Dr. Mendez:

“For an average woman with no significant risk factors, the recommendation is a baseline mammogram anytime between age 30 to 40, and, then, provided there are no abnormalities, an annual mammogram starting at age 40. And we know the denser the breast tissue, the more important it is to complement that with a breast ultrasound. It’s part of doing a more thorough evaluation.”

Dr. Fialkow:

“You mentioned some of the non-modifiable risk factors, things you can’t change. One is family history, which speaks to genetics. Can you unpack that a bit?”

Dr. Mendez:

“I want to make it clear that only 10 percent of breast cancers occur in women who have a family history of breast cancer and 5 percent have an identifiable mutation or something in the genetic makeup that really predisposes them to breast cancer. At the time of our initial consultation, or as part of our follow-up, we ask very specific questions about family history. Who was the relative? Is this your mother, your sister? Also we would want to know about any male breast cancer in the family or any other cancers in the family. We ask about ovarian cancer because that’s related to the BRCA genes, which are the most prevalent genes associated with breast cancer. But we also ask about colon cancer, prostate cancer, pancreas, stomach cancer, because we know that certain genetic mutations are also associated with the gene. It helps us stratisfy the risk so we can determine who might benefit from a genetic consultation and actual genetic testing.”

Dr. Fialkow:

“If someone is high risk, what is the next step?”

Dr. Mendez:

“We have models to help us calculate. One that is most commonly used is the Tyrer-Cuzick Eighth Edition model, where it takes a lot of these factors in consideration. It gives us a percentage probability of that woman developing breast cancer within 10 years and during their lifetime. If someone indeed has high risk, usually greater than 20 percent, in addition to the increased surveillance, we will follow that patient with a breast MRI.”

Dr. Fialkow:

“During COVID-19 we’re seeing a decrease in women getting their mammograms. Can you speak to how important it is to maintain your screening, your routine screening process?”

Dr. Mendez:

“It’s very important to maintain the screening. Early detection is key for improved outcomes and improved survival. In addition to screening, it’s important to know your family history and your body. I cannot underscore the importance also of breast self-exam. I can assure patients that the imaging centers are following COVID-19 guidelines in terms of safety. I encourage all women to go and seek their mammogram so that we can attend to their needs and continue with prevention.”

Dr. Fialkow:

“Can we talk a little about the Breast Cancer Prevention Clinic at Miami Cancer Institute?”

Dr. Mendez:

“In this clinic we are trying to identify a very specific patient population at increased risk of breast cancer because of their family history, certain pathologic conditions, previous radiation or because they have been identified to have some of these high-risk mutations. We will tailor a prevention plan, including genetic consultation if needed, and nutrition and exercise plans so that they can monitor all of the different components that are critical in order to maintain a healthy lifestyle. Instead of becoming a breast cancer survivor, they can continue as a previvor. So that’s a great concept.”

Dr. Fialkow:

“There’s also a Benign Breast Cancer Clinic. Could you speak a little about the benefit of that?”

Dr. Mendez:

“This clinic focuses on non-cancerous conditions. We make sure that in their clinical exam, everything is normal, as well as in their imaging. These are women who might be having breast pain or cysts or other benign conditions and need to be reassured by an expert so that they can move on, and, receive proper follow-up when needed.”

Dr. Fialkow:

“And how about survivorship programs?”

Dr. Mendez:

“It’s not only about surviving the breast cancer, but also living your life with good quality and any adjustments. Currently in the United States we have 3 million breast cancer survivors because of all the advances and technology. We have a whole program of survivorship, everything from psychological support to yoga classes, to acupuncture, to nutrition and obviously healing. Whatever is needed to keep the patient not only cancer-free, but with great quality of life.”