For Referring Providers 鈥� High Risk Breast Clinic (HRBC)
The High Risk Breast Clinic provides specialized risk assessment, screening, and prevention strategies for patients at elevated risk of developing breast cancer. Referrals are reviewed by the clinical team and prioritized based on medical urgency and risk profile.
Before Submitting a Referral
Refer to Cancer Genetics First When Appropriate
If a hereditary cancer syndrome is suspected and the patient has not yet undergone genetic counselling or testing, please refer the patient to the Cancer Genetics Service prior to submitting an HRBC referral. Patients identified as high risk through genetic evaluation who require enhanced screening or prevention may subsequently be referred to the High Risk Breast Clinic.
Hereditary Breast/Ovarian Cancer (HBOC) Referral Form (PDF): Download
Submission: Please fax both pages to 514-340-8712.
Refer Directly to the HRBC If the Patient Has:
- Atypical breast lesions (e.g., LCIS, ALH, ADH, or other high-risk pathology)
- Chest wall radiation prior to age 30
- A known pathogenic variant (e.g., BRCA1/2, PALB2, TP53) requiring ongoing surveillance
- Strong family history and/or elevated lifetime risk calculated using validated models
- Completed genetic evaluation and requires specialized prevention follow-up
HRBC Referral Form (PDF)
This form must be completed by a licensed healthcare provider to refer a patient to the High Risk Breast Clinic for assessment and triage.
HRBC Referral Form (PDF): Download
What to Include with the Referral
Providing complete documentation supports timely triage.
- Reason for referral and key risk factors
- Relevant pathology reports (especially for atypia or LCIS)
- Most recent breast imaging reports (mammogram, ultrasound, MRI)
- Genetic test results (if available)
Submission Instructions
Please complete the referral form in full and email it securely to highrisk.breastclinique.ccomtl [at] ssss.gouv.qc.ca. Incomplete referral forms may delay triage and processing.
Alternate submission methods
- Fax: 514-340-8600
- Drop-off: Pavilion E, Room E-740
Wait Times
Referrals are reviewed and prioritized based on clinical urgency and clinic capacity. Typical wait times range from 6 months to 1 year.
Contact
- Clinic Phone: 514-340-8222 ext. 28775
- Clinic Email: highrisk.breastclinique.ccomtl [at] ssss.gouv.qc.ca