Prevention

Breast and ovarian cancer prevention

The Breast and Ovarian Cancer Prevention (BOCP) Clinic at Seattle Cancer Care Alliance (SCCA) is for people with a higher risk for breast cancer and/or gynecological cancers. We help patients reduce risk by making personalized prevention and early detection surveillance plans for them.

Before coming to us, patients often have genetic testing done. Then, if a genetic risk is identified, they will come to the BOCP Clinic. Or, if they have a higher risk due to significant family history of breast cancer, they will go to our Breast Health Clinic. Sometimes this pathway can change, depending on the patient.

Not sure where you should be seen? We can help. It’s our job at SCCA to find the best care for you. If you have questions, call us at (206) 606-6100.

Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.

The BOCP clinic is located at SCCA Wellness Center. Get a map, directions and other details about this location.

Breast and Ovarian Cancer Prevention Clinic

phone (206) 606-6100
Hours: Monday to Friday, 8 am–5 pm
fax (206) 606-6135

Telehealth appointments available

We also offer telehealth (online) appointments that you can access conveniently from anywhere using your computer, smartphone or any Internet-connected mobile device. To ask if a telehealth video visit is right for you, call us at (855) 557-0555.

What happens at your first appointment

Before your visit to the Breast and Ovarian Cancer Prevention Clinic at SCCA, our experts will review your medical records, your family history of cancers and the results of any tests you may have completed elsewhere. We will also send you some questions, which you will need to answer and return to us before you schedule your first appointment.

Once we have this information, we will schedule a time to discuss your results and work with you to build your personalized prevention and early detection surveillance plan. The goal is to reduce your risk of developing cancer and to find cancer early when it can be more easily treated, if it does occur. 

During this appointment, and depending on your unique risk profile, you may meet with one or more providers, such as a medical oncologist, breast health physician, gynecologic oncologist, genetic counselor or registered dietitian. The length of the visit depends on how many appointments you have, but it is usually about two hours.

Your plan will be as unique as you are. We partner closely with SCCA’s Clinical Genetics and Counseling Service. We may recommend that you get screened at an SCCA surveillance clinic. This may include visits to SCCA Wellness Clinic for routine exams and close monitoring or visits to the SCCA High Risk Surveillance Clinic. In some cases, your prevention plan can be managed by the provider who referred you to us or your primary care provider.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.
What is included in my personalized prevention plan?
  • Information about hereditary (passed down in your family) and nonhereditary breast or gynecological cancer risk factors 
  • Ways to lower your breast or gynecological cancer risk
  • Information about clinical trials you are eligible to be part of through SCCA and our partners at Fred Hutchinson Cancer Research Center and the University of Washington Medical Center 
  • A letter with a detailed summary of your visit
Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited.
What are some of the strategies that may be used to reduce my risk?

Your BOCP multidisciplinary team will work with you to customize a plan that may include:

  • Blood tests
  • Chemoprevention or medication
  • Imaging, like mammograms, ultrasounds or magnetic resonance imaging (MRI)
  • Lifestyle changes, such as changes in diet and exercise
  • Participating in clinical trials, if you choose
  • Risk-reducing surgery
  • Screening with physical exams
Chemoprevention The use of drugs, vitamins or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.
“Finding out that you are at risk for ovarian cancer can lead to significant worry. In this clinic, we give our patients the tools to help them manage their risk. They are not in this alone, and we will use our knowledge to build a plan that is right for them.”
— Barb Norquist, MD, Medical Director, Breast and Ovarian Cancer Prevention Clinic

Frequently Asked Questions (FAQs)

What does “a strong family history of breast or ovarian cancer” and “high risk” mean?

Family history and genetic testing both provide important clues about your risk level. You may be at high risk of developing breast or gynecological cancer if:

  • You had an abnormal result on your genetic test, such as testing positive for a BRCA1 or BRCA2 pathogenic variant
  • You have Lynch syndrome or another genetic abnormality linked with breast cancer, ovarian cancer or uterine cancer
  • Two or more relatives on the same side of your family have had breast or ovarian cancer, especially if the breast cancer was diagnosed before age 40
  • A relative had cancer in both breasts
  • A relative had both breast and ovarian cancer
  • Male relatives have had breast cancer
Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
What is genetic counseling?

Genetic counseling is the process of providing education and emotional support to patients about inherited conditions and how they impact a person and their family. The goal of genetic counseling is to provide clear, useful information about genetic risk factors in a way that helps you learn more and make decisions about cancer treatment, prevention or early detection.

Why is prevention especially important for people with a genetic risk towards breast or ovarian cancer?

If you have a genetic risk for a breast or gynecological cancer, more frequent screening and surveillance will allow your physicians and care providers to find any abnormalities in their early stages, when they can be more easily treated. And, for some patients at risk of breast or gynecological cancer, risk reduction surgery can reduce their risk by a lot. 

If you do develop a type of breast or ovarian cancer, knowing your genetic test results can lead to more effective, precise treatments, which can mean better outcomes for you.

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.

Care team

Our integrated approach to breast and ovarian cancer prevention brings together experts from a variety of specialties within Seattle Cancer Care Alliance (SCCA).

Advanced practice provider

These health care professionals work closely with your physician. There are two types: physician assistants (PAs) and advanced registered nurse practitioners (ARNPs). They help provide and coordinate your treatment and can see you without your physician. They also help manage any effects of your disease and treatment.

Nurse practitioner A registered nurse who has additional education and training in how to diagnose and treat disease. In cancer care, a nurse practitioner may manage the primary care of patients and their families. A registered nurse who has additional education and training in how to diagnose and treat disease. Nurse practitioners are licensed at the state level and certified by national nursing organizations. In cancer care, a nurse practitioner may manage the primary care of patients and their families, based on a practice agreement with a physician. Physician assistant A health professional who is licensed to do certain medical procedures under the guidance of a physician. A health professional who is licensed to do certain medical procedures under the guidance of a physician. A physician assistant may take medical histories, do physical exams, take blood and urine samples, care for wounds and give injections and immunizations.
Breast health specialist

If a physician discovers an abnormality in a patient’s breast, they may refer them to a physician known as a breast health specialist. The breast health specialist will do more tests to find out whether the abnormality is cancerous or noncancerous. A breast health specialist may also work in breast cancer prevention and develop plans for reducing risk.

Breast medical oncologist

If a patient is diagnosed with breast cancer, they may be seen by a breast medical oncologist. This specialist will decide what types of medicine-based treatments might help the patient, such as chemotherapy or endocrine therapy to treat a hormone-related cancer. Medical oncologists can also prescribe medicine to help prevent cancer from spreading, slow its growth and reduce symptoms related to cancer.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Genetic counselor

This specially trained health care provider helps you understand your risk of a genetic disorder. A genetic counselor can also determine if genetic testing could be helpful for you, based on your personal and family medical and health history. After you have had genetic testing, a genetic counselor can offer information and resources for prevention; connect you with prevention programs, such as those available at SCCA; and help with testing your family members, based on your results. SCCA Genetic Counseling Service providers are all licensed, board-certified genetic counselors.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
Gynecologic oncologist

If a patient is diagnosed with a gynecologic cancer, is suspected to have a gynecologic cancer or is at higher risk of gynecologic cancer, they may be seen by a gynecologic oncologist. Gynecologic oncologists provide complete surgical and medical care, including chemotherapy if needed. Some examples of conditions treated by gynecologic oncologists are ovarian cancer, endometrial cancer, cervical cancer, vulvar cancer, advanced gynecologic surgery and inherited risk of cancer.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.
Patient care coordinator

The patient care coordinator will likely be one of the first people you meet when you come to SCCA. They will gather your medical records and family health history and help guide you to the appropriate genetics or prevention care services within SCCA.

Registered dietitian

Registered dietitians are credentialed food and nutrition experts. To earn this title, they must go through a lot of training and formal education, including doing an internship and passing a national registration exam. Registered dietitians provide medical nutrition therapy, which means they use an evidence-based approach to treat and help patients manage medical conditions through diet and nutrition.

Physician assistant A health professional who is licensed to do certain medical procedures under the guidance of a physician. A health professional who is licensed to do certain medical procedures under the guidance of a physician. A physician assistant may take medical histories, do physical exams, take blood and urine samples, care for wounds and give injections and immunizations.
Registered nurse

Your nurse manages your care alongside your physician. They also assist with procedures and treatments. Nurses are resources for you and your caregiver. They answer questions and help with a wide range of topics, like how to cope with side effects or get other services you need at SCCA.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Social worker

SCCA social workers are professionals who are trained to offer support to patients who have received a cancer diagnosis, are going through cancer treatment or are in recovery. They also work with people who are at high risk for cancer. Oncology social workers are key team members who have the knowledge and resources to help connect you with the right resources, such as psychiatry and psychology services, to support you through preventive care or treatment.

Find care team profiles

Meet the caring, dedicated people who take care of you and your family at SCCA.

Denise L. Bundow, ARNP
Denise L. Bundow, ARNP
Advanced Registered Nurse Practitioner
Advanced Practice Provider
Ellen  Chuang, MD
Ellen Chuang, MD
Physician
Medical Oncology
Natasha B. Hunter, MD
Natasha B. Hunter, MD
Physician
Medical Oncology
Barbara Stulken Norquist, MD
Barbara Stulken Norquist, MD
Physician
Gynecologic Oncology
Katy  Pennington, MD
Katy Pennington, MD
Physician
Gynecologic Oncology
Elizabeth M. Swisher, MD
Elizabeth M. Swisher, MD
Physician
Gynecologic Oncology
Rachel L. Yung, MD
Rachel L. Yung, MD
Physician
Medical Oncology

Supportive care services

Raymond Palko, MS, RD, CSO, CD
Raymond Palko, MS, RD, CSO, CD

Raymond Palko is a registered dietitian who works with patients who are at high risk of developing breast or ovarian cancer. He also works with patients with breast, renal and endocrine cancers and melanoma, as well as supporting them after treatment. Raymond sees patients at SCCA South Lake Union and SCCA Issaquah. Raymond is a board-certified specialist in oncology nutrition.

Cynthia Handford, MSc, CGC, CCGC
Cynthia Handford, MSc, CGC, CCGC

Cynthia Handford has been a genetic counselor since 2007 and has worked in both clinical and laboratory settings. She has a special interest in hereditary cancer and enjoys helping patients and their families use genetic information to be proactive with their health. Cynthia is certified by the American Board of Genetic Counseling as well as the Canadian Association of Genetic Counselors and licensed by the Washington State Department of Health.