I had several talks, my first two talks were really talking about that some women need more screening than others. So my first talk was about identifying women that are very high risk for breast cancer because they need more screening, typically with MRI, and starting at a younger age. Then my second talk was about women with dense breasts, although even when they’re average risk mammography is just not enough, that the sensitivity for mammography for women with very dense breasts is only 50% whereas overall it’s at least 70%. So how can we get those women up to that higher level of early cancer detection and that’s primarily through ultrasound but also we’re exploring other tests like functional imaging such as abbreviated MRI and contrast enhanced mammography. Then I did several talks that were related to basically having an algorithmic approach to lesions. I did one on MRI, one on probably benign lesions in the breast and one on axillary evaluation.

Could you go into more detail on your presentation about high risk breast cancer patients?

Mainly these are women that have a strong family history of breast cancer and in their family these mutations drive other cancers as well in men and women. You’re looking for women who have a strong family history of breast and other cancers – ovarian, yes, that would be the BRCA genes, but other cancers as well like thyroid cancer, for example, that suggests that they may have Cowden syndrome which is a PTEN mutation. We’re finding more and more mutations that increase the risk of getting breast cancer so whereas we used to do genetic testing for BRCA and really that was it, now it’s BRCA and many, many, many other mutations. So we do multi-gene panel testing but first we have to figure out who those women are so we have to ask about family history.

Then there are other women that are at high risk because of multiple risk factors. Let’s say a woman’s mum had breast cancer and maybe she’s had an abnormal biopsy showing some atypia, maybe she had children at a later age. So lots of smaller risk factors, none that suggest that she has a genetic mutation but together may increase her risk. So for those women we have to use a risk model. We talked a lot about which risk models to use, how to use them in your centre and that sort of thing.

Are these methods accessible for all of the physicians attending the conference from different areas of the world?

I was really pleased, a lot of people are using risk models in their practice. It is more work because you have to collect all that data from the patients but the good news is you only have to do it once and then you just have to update them. And those resources are available on the internet for free if you’re not using them for commercial purposes. So if you’re just using them in your clinic to assess a patient anybody can do it and that’s a fantastic thing, it just takes a little extra time.

Were there any other main messages from the presentations you gave that you would like to raise?

First we want to identify women that are at higher risk and really what we want to do is MRI for those patients. Maybe not all those women can get MRI so we also talked about other ways to screen women that are at elevated risk or have dense tissue. So that might be contrast enhanced mammography, for example, which they are doing a lot of here. There was a nice talk on that topic here at the session. And also abbreviated MRI which is evolving.

Is there anything else you would like to add?

It’s been a fantastic meeting and people here are such fantastic hosts. It’s just so warm and friendly so it’s really been a pleasure visiting.