Patient & Provider Forms

Forms for Patients

Some forms are multiple pages; please complete all pages.

New Patient Welcome Packet - Cancer Survivorship

New Patient Welcome Packet - Genetic Counseling

New Patient Welcome Packet - GYN Oncology

New Patient Welcome Packet - High-Risk Breast Program

Release of Medical Records Form

Forms for Providers

Referral Form

High-Risk Breast Program

All women are at risk for breast cancer, but some women have a higher risk than others. Women who are at a higher risk for developing breast cancer may need additional screening, management, or treatment. Led by Charu Taneja, MD, our team of breast health specialists will provide a comprehensive evaluation for individuals at risk.

Who Is at High Risk for Breast Cancer?

Certain conditions can increase a woman’s lifetime risk of developing breast cancer.

Some of these conditions or risk factors include:

  • Atypical findings on a mammogram
  • Multiple prior breast biopsies
  • Atypical findings on a previous breast biopsy
  • Family or personal history of breast or ovarian cancer
  • A BRCA1 or BRCA2 gene mutation
  • Known cancer mutation in your family
  • Radiation treatment to the chest area between ages 10 and 30
  • Hereditary cancer syndromes including Li-Fraumeni Syndrome and Cowden Syndrome
  • A calculated risk of breast cancer that is 20 to 29 percent, based on family history, personal health history, or genetic markers

How Is a High Risk for Breast Cancer Treated?

After you have been evaluated for your risk of breast cancer, our team will work with you to develop a plan of care and will consider if any of the following are appropriate for you:

  • Additional imaging
  • Frequent follow up
  • Genetic testing
  • Risk reduction with medication if lifetime risk is greater than 20 percent

Women who are determined to be at a higher risk for breast cancer may need additional screening. The screening guidelines for women who are at high or very high risk may include:

  • Increased and earlier screening
  • Breast magnetic resonance imaging (MRI)
  • Breast self-exam starting at age 18
  • Clinical breast exam once or twice yearly starting at age 25
  • Annual mammogram starting at age 25 to 30 or earlier, based on family history

For some women, other treatments or surgery may be required. These options can include:

  • Mastectomy, or the surgical removal of the breasts, can lower the risk for breast cancer by 95 percent.
  • Surgical removal of the ovaries and fallopian tubes can lower the risk for breast cancer by 30 to 50 percent.
  • Chemoprevention

When Should I See My Doctor If I Am at High Risk for Breast Cancer?

To understand your risk for breast cancer and what you can do to manage it, consult with your doctor. In addition to receiving your regular screenings and performing regular self-exams, let your doctor know of any personal or family history of breast cancer.

If you are referred to the High-Risk Breast Program at the Women’s Medicine Collaborative, our team will provide a personalized care plan to manage your risk.

The Women’s Medicine Collaborative is a convenient, comfortable setting dedicated to women’s health.

For more information or to schedule an appointment, call 401-793-7917.

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Locations

High-Risk Breast Program
West River Center
146 West River Street
Providence, RI 02904
3rd Floor Suite 11-D
146 West River Street
Providence, RI 02904