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People at increased risk of breast cancer may benefit from a screening approach that differs from average-risk screening. Your HRBC plan is individualized and based on your risk factors, medical history, and (when applicable) genetic test results.

Why high-risk screening can be different

• High-risk screening may include breast MRI in addition to mammography for eligible patients.
• Some patients may have imaging at different intervals (for example, alternating modalities across the year).
• Recommendations are personalized to balance benefits, limitations, and patient preferences.

Typical modalities discussed

• Mammography (often with 3D/tomosynthesis when available)
• Breast MRI (for eligible patients)
• Breast ultrasound (in selected circumstances)

If MRI is not possible

If MRI is contraindicated (for example, due to certain implants) or not tolerated, your care team will discuss other appropriate screening approaches based on your individual risk profile.

Risk-reduction options

Risk-reduction is personalized and may include one or more of the following:

Lifestyle-based strategies

• Physical activity and exercise counselling
• Weight management support
• Limiting alcohol intake
• Smoking cessation support
• Nutrition counselling when appropriate

Medications (Endocrine Prevention)

Some patients may benefit from medications that can significantly reduce the risk of developing breast cancer. The decision to initiate endocrine risk-reduction therapy is individualized and based on factors such as menopausal status, overall breast cancer risk, medical history, and tolerance for potential side effects. These options will be reviewed with you in detail during your consultation.

Commonly prescribed medications include:

• Tamoxifen – may be used in both premenopausal and postmenopausal patients

• Raloxifene – typically used in postmenopausal patients

• Aromatase inhibitors (e.g., anastrozole, exemestane) – used in select postmenopausal patients

Before starting therapy, a comprehensive medical assessment will be performed to ensure treatment is safe and appropriate.

Common contraindications may include:

• Personal history of venous thromboembolism (deep vein thrombosis or pulmonary embolism)

• Prior stroke or significant cerebrovascular disease

• Active liver disease

• Current pregnancy, planned pregnancy, or breastfeeding

• Known hypersensitivity to these medications

Additional considerations:

• Tamoxifen: may not be recommended for patients with a history of endometrial cancer or unexplained abnormal uterine bleeding.

• Aromatase inhibitors: require caution in patients with severe osteoporosis or high fracture risk.

Not all contraindications apply to every medication. Your healthcare provider will carefully review your medical history and discuss the benefits and potential risks with you to determine the most appropriate prevention strategy.

Surgical risk reduction

For selected individuals with very high inherited risk, surgical risk-reduction options may be discussed. Referrals to breast surgery, plastic surgery, and/or gynecology are coordinated as appropriate.

This page provides general information and does not replace medical advice. Your plan is individualized.