Doctors have for years asked women the same set of questions — age of first period, age of first child, to name a few — before their mammograms.

But then, at least in Central Oregon, not much has been done with that information. It gets tucked away in a file and might be revisited years later in the event that patient is diagnosed with breast cancer.

“Because then you would go, ‘Oh, you’re 42 and you have a breast cancer and your mom was 50 when she had her breast cancer? What’s going on in this family?’” said Dr. Andy Higgins, a breast cancer surgeon. “That’s when it would happen, and it was after the fact. So, how can we do it before the fact?”

Partly due to the increasing advances in modern medicine’s ability to determine people’s predispositions to certain diseases, including cancer, lots of focus has shifted toward identifying patients’ risks. To that end, St. Charles, Central Oregon Radiology Associates (CORA) and surgeons from Bend Memorial Clinic have teamed up to launch Central Oregon’s first High-Risk Breast Clinic on June 1. It’s designed to give patients more specific breast cancer risk assessments, teach them about breast cancer prevention and create personalized plans for regular screenings or even surgical interventions.

Under the new program, anyone who receives a mammogram at Central Oregon Radiology Associates — where St. Charles sends all its patients — or at Bend Memorial Clinic will be asked a standard set of questions known as the Gail model. Based on their answers, they’ll be given a lifetime risk of developing breast cancer. If their risk is 20 percent or greater, a clinic coordinator will contact them and ask whether they wish to participate in the High-Risk Breast Clinic. If they answer yes, they’ll meet with one of four breast cancer surgeons participating in the clinic, who will take them through a more comprehensive evaluation of their risks.

Based on that evaluation, patients determined to potentially have a genetic risk will see Dr. Cora Calomeni, a medical oncologist with St. Charles, who will determine whether a blood test to identify a genetic mutation is necessary.

Genetic tests can run in the thousands of dollars but are usually covered under insurance policies, said Dr. Linyee Chang, medical director of the St. Charles Cancer Center. There is no cost to being a member of the breast cancer clinic, and the educational materials are free, but the consultations with physicians will be charged like any other doctor visit, she said.

Between 5 and 10 percent of breast cancer cases are caused by genetic mutations, most commonly in the BRCA1 and BRCA2 genes. People born with these mutations are at a higher risk of developing breast cancer, between 55 percent and 65 percent with BRCA1 mutations and around 45 percent with BRCA2, according to the American Cancer Society.

But women can still be considered at high risk of developing breast cancer even without the genetic mutations. Between 90 percent and 95 percent of cases are caused by other risk factors, such as a family or personal history of the disease, race, dense breast tissue and having started her period earlier than age 12, among others, according to the cancer society.

For the larger group with nongenetic risks, doctors will discuss the preventive benefits of improving diet and exercise and lowering alcohol consumption, Chang said. The doctors will also teach the patients how to perform breast self-exams and provide information about support services for women at higher risk of breast cancer. They’ll also develop a schedule for imaging studies with the patients, Chang said.

“There are things that can really empower them to reduce their personal risk,” she said, “and just to provide this higher level of support for this population. When we catch breast cancer early, there is the potential that our treatments could be a lot less intensive. So it’s important to catch it early.”

Unfortunately, those found to have the genetic mutations would not be able to reduce their risk by changing their diet and exercise habits, although better overall health is crucial when facing treatments if they are diagnosed, said Dr. Cloe Shelton, CORA’s director of women’s imaging.

For that smaller group, the decisions become more high stakes. Some women choose to undergo double mastectomies, surgical procedures in which the tissue in both breasts is removed to prevent breast cancer from developing.

Actress Angelina Jolie famously revealed in a New York Times op-ed in 2013 that she had undergone a voluntary double mastectomy after learning she had the BRCA1 mutation. She said her doctors estimated she had an 87 percent lifetime risk of developing breast cancer. Since Jolie’s announcement, other women have spoken about their decisions to undergo the procedures.

Hearing stories like those inspire other women to undergo the preventive surgeries before being diagnosed, Higgins said.

“I’ve had a couple already in my practice,” he said. “My hunch is as this evolves, as this gets going forward, there probably are going to be more women that choose aggressive surgical approaches.”

Still others with genetic mutations will choose to wait and see whether the breast cancer develops and, if it does, treat it then.

“It’s not a 100 percent risk,” Chang said. “That is not a black-and-white decision. Not all gene-positive women choose to have bilateral mastectomies, nor do they have to.”

Shelton, of Central Oregon Radiology Associates, came up with the idea for the High-Risk Breast Clinic after having worked in a similar one during her fellowship training at Brigham and Women’s Hospital in Boston. She grew concerned when she saw that the information from the Gail questions weren’t really being used to calculate women’s lifetime risk in Central Oregon and saw the clinic as a way to change that.

While such programs are common in larger metro areas such as Boston, they’re unique for communities the size of Bend.

“This is the standard of care at big institutions,” she said. “Especially for our-sized community, it’s a much-needed offering.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

Editor’s note: This article has been corrected and clarified. An earlier version of the story misidentified Dr. Andy Higgins’ employment, as well as BMC’s limited role in the clinic. It was also unclear about how BMC patients are questioned about their breast cancer risk.

The Bulletin regrets the errors.