Managing Risk to Save Lives

High-risk Breast Program uses information in a new way

Advancements in technology have afforded us more patient-centric data that is actionable. Now, a team from Baylor Scott & White Health is utilizing that information to make important predictions about breast cancer in its new High-risk Breast Program.

“Up to 15 percent of women appearing at any time at a breast center are at a high risk for breast cancer— and they don’t even realize it,” Zeeshan Shah, M.D., Medical Director, Darlene G. Cass Women’s Imaging Center at BUMC and North Dallas, said.

Developed with these women in mind, the program assesses risk, counsels patients about reducing risk factors within their control, and provides comprehensive, personalized follow-up care. The program puts years of scientific findings to work for women to identify and understand their risk factors through the use of new software systems that illuminate a patient’s potential for developing breast cancer, all based on complex algorithms that integrate and analyze a host of risk factors.

With the help of a dedicated navigator, patients can discover and then act on that information. Additional testing may be conducted that has the potential to uncover even very small amounts of abnormal cells. Patients are provided counsel and support from an experienced care team every step of the way.

“We automated the process of determining risk, and ancillary technologies became available that let us do something with that information,” Dr. Shah explained.

Most important, he stresses, is the human element. “One of the challenges for me was to make sure this process was personal. It’s important to have a human face to this to make it a patient-friendly experience.”

Doctor Zeeshan Shah is a fellowship-trained breast imager with extensive clinical experience who is board certified in diagnostic radiology from the American Board of Radiology. With an undergraduate degree in religion from Wabash College, Dr. Shah earned a degree in medicine from the Indiana University School of Medicine. He is the medical director for the Darlene G. Cass Women’s Imaging Center at Baylor University Medical Center and North Dallas.

How did the idea for the High-risk Breast Program come about?
Over the past five years, the medical community had a change in mammography guidelines, and many of the guidelines are dependent on a woman’s individual risk. But this struck me: Patients with a higher-than-average risk often don’t know that they have this risk. The screening guidelines are based on risk—but who is figuring out risk? In radiology, we are often the first ones to inform patients of their diagnosis, before they follow up with an oncologist or surgeon, so it is our mission to become experts on risk.

How does understanding risk help patients?
While there are some risk factors you can control (quitting smoking or keeping a healthy weight, for example) there are many risk factors that you cannot alter (your height, for example). So what can we do for those at a higher risk? Look for it more. Find it early. Screen patients more often and with different technologies than we would a person with normal risk. Pair a screening mammogram with a different tool. That’s why we have to have different screening modalities.

More people are talking about risk, especially with the passing of Henda’s Law. How does your vision complement this progress?
One of the challenges for me was to make sure that this program was personal. It’s good that more people are becoming aware of risk, but we need to change the tone. Let’s have the nurse discuss your risk with you face to face. Let’s give more detailed information about what to do next. And then, if your risk is indeed higher based on analytics, let’s set you up with an additional screening modality and have a human navigate you through this. Let’s make this a patient-friendly experience.

What drew you to the field of mammography?
This is a definable disease process that affects a lot of patients, and something can be done to help them. It’s just a matter of finding it! My parents brought me up to believe that whatever you do in life, you should have an impact beyond yourself and your home. This is an area of medicine where I felt I could have an absolute impact.

The sad truth is that one in eight women will develop breast cancer in their lifetime. That number is huge; it’s terrifying. I think of all the women around me—my wife, Mona, and my nine-year-old twins, Zoya and Sabrinah, who will one day grow up, as well as other women around me. To think that even one of them may have to face this drives me to do better—for them, for everyone. My wife and I have always talked about the fact that we want to have an impact on the world around us.