Skip to main content

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.

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. 

 

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.

Trans women who have developed breast tissue due to the use of exogeneous estrogens and testosterone blockage should follow the same screening protocols for their mutation as those assigned female at birth.

 
Our team
Dr. Rona Cheifetz, Medical Lead

Mr. Marco Gnoato, Nurse Practitioner

Clerk



Page last reviewed January 2023.
SOURCE: High Risk Clinic ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © BC Cancer. All Rights Reserved.

    Copyright © 2023 Provincial Health Services Authority