Presbyterian Hospital has initiated a Breast Cancer Risk Assessment Service, designed to identify and track women at higher-than-average risk.

Elizabeth Krause is a perfectly healthy 40-year-old woman. So it's surprising to learn she has oncologists, breast surgeons, radiologists and nurse practitioners watching over her like an army of cancer-killers, ready to pounce at the first sign of breast cancer.

But a new Breast Cancer Risk Assessment Service at Presbyterian Hospital of Dallas identified Elizabeth at "high risk" because she carries a mutation of the BRCA gene, which predisposes her to the disease.

"So many doctors' appointments remind me of the thing that frightens me most," she said, "but so many doctors' appointments might just keep that thing - breast cancer - at bay forever. Or it may save my life if the disease ever does show up."

Presbyterian's Breast Cancer Risk Assessment Service, designed to identify and track women at higher-than-average risk, is modeled after programs at MD Anderson Cancer Center and Harvard Medical Center.

Women who come through Presbyterian's breast center for a routine mammogram will be offered use of a laptop computer to take a test to determine their risk of developing breast cancer. Those identified at high-risk will be offered enrollment in the high-risk surveillance part of the program, which offers genetic testing, breast MRI, 3D mammography, and consultations with physicians at Presbyterian.

"Without this assessment, many of these women would be going about their normal lives not realizing they were at higher-than-normal risk for the disease," program director Daphne McDonald said. "While all women are at risk for breast cancer, women at high-risk need additional surveillance and education tools to help prevent the disease or diagnose it early when it does occur."

The program will teach self breast-exam techniques, and educate women about how diet and exercise can lower their risk. Women who carry the BRCA gene mutation will automatically be given a breast MRI. A positive test for this familial gene also will prompt the computer to generate a letter the woman can choose to send to first-degree relatives.

"We know that screening for breast cancer reduces mortality," said breast surgeon Dr. Lee Bourland, medical director of Presbyterian's Breast Care Program. "Our breast cancer risk assessment service first identifies the women with extraordinary risk and secondly assures that they receive the benefit of appropriate and regular screening."

Factors that place a woman at high-risk include a family or personal history of breast cancer, history of ovarian cancer, an abnormal breast biopsy, or the BRCA gene mutation.

"Learning about their risk factors for breast cancer shouldn't be something that's scary for women," said oncology breast surgeon Dr. Kandice Kilbride. "The reality is that we're all at risk; denial doesn't make the cancer risk go away. This program simply measures what level of risk and gives women the tools to address those risks."