IBCORA Project

The IBCORA Project is Appalachian Medical Professionals' effort to Improve Breast Cancer Outcomes in Rural Appalachia. It relies on providing women and their Primary Care Providers current and trustworthy information upon which to base their health care decisions. It incorporates recommendations about breast imaging, genetics evaluation and how to acquire the "Goldilocks ABC Plan", Appalachian Breast Care that's: Not too little. Not too much. Just right for you!

A Patient's Perspective

Goldilocks Page

A Doctor's Perspective

Message from Dr. Barker

To bring this approach to life, meet Goldilocks, a 38-year-old virtual breast cancer survivor and advocate for The Goldilocks Screening Plan. Inspired by real-life stories of women whose cancers were found through proactive screening, and the profound impact early detection can have on them and their families, Goldilocks shares her story to show why taking small, proactive steps can make a life-changing difference. Read more about Goldilocks, her family, and the story on our Goldilocks page.

Use the resources on this website to understand your personal risk and learn what experts recommend.

Your 3-Step Assessment:

Take The Goldilocks ABC Plan Assessment below to determine your risk category.
Follow the Protocol recommended for your risk category.
Find out if you qualify for free genetic testing in the Free Genetic Counseling section.

Need help determining your risk category or finding the right resources? Visit our Contact page and we’ll be happy to help.

Our Risk Assessment

The Goldilocks ABC Plan and Our Risk Assessment

How to Take Our Assessment: Review the questions below and identify which apply to you. Then, follow the recommended protocol for your risk category

in the Protocols section.

1. If you have ever been diagnosed with either Invasive Breast Cancer or Ductal Carcinoma InSitu (DCIS) scroll to Protocols, click Surveillance and Follow-up.

2. If you currently have any breast symptoms, scroll to our Breast Symptoms Section below or click here.

3. If you ever had a breast biopsy that showed Atypical Ductal Hyperplasia (ADH) or Lobular Carcinoma InSitu (LCIS) scroll to Protocols, click Increased Risk/ADH/LCIS.

4. If you ever had a mammogram that was reported as "Heterogeneously Dense" or "Extremely Dense", scroll to Protocols, click Increased Risk/Dense.

5. If you have been told you have a lifetime risk of being diagnosed 20% or higher, scroll to Protocols, click Increased Risk/20%. You can also calculate this for yourself by clicking here and following the directions: http://ibis.ikonopedia.com.

6. If you are 35 or older and have a 5year residual risk of being diagnosed with breast cancer of 1.7% or higher, scroll to Protocols and click Increased Risk/1.7%+. You can calculate this for yourself by clicking here and following the directions: www.cancer.gov/bcrosktool.

7. If you have been told that you are a carrier of any of these genetic variants: BRCA1/2, TR53, PTEN, PALB2, CDH1, or STK11, scroll to Protocols and click Increased Risk/ Gene.

8. If you received radiation therapy to the chest wall when you were 10-30 years old, for instance, for Hodgkin's Lymphoma, scroll to Protocols and click Increased Risk/RT.

9. If none of the above questions apply, you are probably at average risk; scroll to Protocols and click Average Risk.

Protocols

Breast screening plans are not the same for everyone. Not every woman needs the same tests at the same ages. Once you have taken the self-assessment above, click on your risk category to see what protocol you should follow.

Protocols

Surveillance & Follow-Up After Breast Cancer

Category 1

For people who have finished breast cancer treatment.

Check-ups: Exam 1–4 times a year for 5 years, then once a year.
Mammogram: Every year. After lumpectomy, first one is 6–12 months after radiation. No routine imaging of a rebuilt (reconstructed) breast.
No routine scans or blood tests to look for spread unless you have symptoms.
Keep taking any hormone (anti-estrogen) pills as directed.
Watch your bones, heart, and arm swelling if your team advises.
Call your team for a new lump, skin change, or lasting bone pain, cough, or weight loss.

Stay active, eat well, limit alcohol, keep a healthy weight.

Increased Risk: 5-Year Risk 1.7% or More

Category 6

Based on a risk tool such as the Gail Model (age 35+) or an imaging-based model.

Exam: Every 6–12 months.
Mammogram (3-D): Every year.
Breast MRI: Talk with your provider about adding a yearly MRI.
- If you can't have MRI: CEM, MBI, or whole-breast ultrasound may be used.
Ask about risk-lowering medicine (such as tamoxifen) and healthy habits.
Know your breasts and report changes promptly.

Have your risk score re-checked over time as your health or family history changes.

Increased Risk: Lifetime Risk 20% or More

Category 5

Based on a family-history risk tool (e.g., Tyrer-Cuzick, BRCAPRO, CanRisk).

Exam: Every 6–12 months.
Mammogram (3-D): Yearly, by age 40 or 10 years before the youngest relative's diagnosis (not before 30).
Breast MRI: Yearly, by age 40 or 10 years before that relative's diagnosis (not before 25).
- Many people alternate mammogram and MRI every 6 months.
- If you can't have MRI: CEM, MBI, or whole-breast ultrasound may be used.
Consider genetic counseling and a breast specialist.
Ask about risk-lowering options.

Your risk should be re-checked over time.

Increased Risk: Known Gene Change or Strong Family History

Category 7

Start with genetic counseling — your plan depends on the specific gene (e.g., BRCA1/BRCA2).

Exam: Usually every 6–12 months.
Breast MRI: Yearly, often starting around age 25 (varies by gene).
- If you can't have MRI: CEM, MBI, or whole-breast ultrasound may be used.
Mammogram (3-D): Yearly, often starting around age 30.
Ask about risk-lowering medicine and risk-reducing surgery.
Family members may benefit from genetic testing too.

Your plan is built around your exact gene result and family history.

Increased Risk: Prior Chest Radiation (Ages 10–30)

Category 8

For people who had chest radiation between ages 10 and 30. Screening starts 8 years after radiation.

If under age 25 now:
- Yearly exam (starting 8 years after radiation)
If age 25 or older now:
- Exam every 6–12 months
- Yearly 3-D mammogram (start 8 years after radiation; not before 25)
- Yearly breast MRI (start 8 years after radiation; not before 25)
- If you can't have MRI: CEM, MBI, or whole-breast ultrasound may be used
Report any breast changes promptly.

If your radiation was outside ages 10–30, ask your provider about your options.

Increased Risk: ADH or LCIS/ALH

Category 3

These cell changes are NOT cancer, but they raise your future risk.

Exam: Every 6–12 months.
Mammogram (3-D): Every year, starting at diagnosis (not before age 30).
Breast MRI: Talk with your provider about adding a yearly MRI (usually not before age 25).
- If you can't have MRI: CEM, molecular breast imaging, or whole-breast ultrasound may be used.
Ask about risk-lowering medicine (such as tamoxifen).
Know your breasts and report changes promptly.

If you fit more than one risk group, your team follows the most complete plan.

Increased Risk: Lifetime Risk 20% or More

Category 5

Based on a family-history risk tool (e.g., Tyrer-Cuzick, BRCAPRO, CanRisk).

Exam: Every 6–12 months.
Mammogram (3-D): Yearly, by age 40 or 10 years before the youngest relative's diagnosis (not before 30).
Breast MRI: Yearly, by age 40 or 10 years before that relative's diagnosis (not before 25).
- Many people alternate mammogram and MRI every 6 months.
- If you can't have MRI: CEM, MBI, or whole-breast ultrasound may be used.
Consider genetic counseling and a breast specialist.
Ask about risk-lowering options.

Your risk should be re-checked over time.

Category 4

Dense breasts are common and normal, but can hide cancer and slightly raise risk.

Heterogeneously dense:
- Exam every 6–12 months
- Yearly 3-D mammogram (by age 40; not before 30)
- Ask about adding extra (supplemental) screening
Extremely dense:
- Exam every 6–12 months
- Yearly 3-D mammogram (by age 40; not before 30)
- Yearly breast MRI recommended (usually from age 50; can consider age 40)
Report any breast changes promptly.

The choice about extra testing is shared — weigh finding more cancers vs. more call-backs.

Average Risk Screening

Category 9

For people with no gene change, a strong family history, prior chest radiation, or other higher-risk conditions. Get your risk checked by about age 25.

Age 25-39:

Clinical visit every 1-3 years (review health and family history)
Know your breasts; report changes

Age 40 and Older:

Yearly Clinical visit
Yearly 3D mammogram
If your breasts are dense, ask about a higher risk plan

When to stop: No set age - depends on your overall health.

Call your provider for a new lump, skin dimpling, nipple change, or size/shape change.

Free Genetic Risk Assessment

Free Genetic Counseling

Your genetic makeup can play an important role in your cancer risk. If you answer yes to any of the following, you may qualify for free hereditary cancer genetic testing — and we can help you get started right here.

Qualifying Questions

1. Have you or a blood relative been told that you have a genetic variant that increases your risk of developing cancer?

2. Have you or a blood relative been diagnosed with any of the following: breast cancer <50, multiple breast cancers, triple negative breast cancer, breast cancer in 3 relatives on the same side of the family at any age, male breast cancer, ovarian, fallopian tube or peritoneal cancer, pancreatic cancer, or metastatic or high-risk (Gleason >6) prostate cancer?

We’ve partnered with Natera, a leading hereditary cancer testing laboratory, to offer comprehensive genetic risk assessment directly through this practice. Natera's Empower hereditary cancer panel tests for dozens of genes associated with hereditary cancer risk and can help guide your care. Click below to start your free risk assessment to determine if you qualify for free hereditary cancer genetic testing through our Natera partnership. Other labs also offer hereditary cancer testing; if you wish to explore additional options, see our Resources page.

You can click on the button below to initiate genetic counseling through Finch Genetics.

Start Free Natera Risk Assessment

Empower Genetic Information Video

Breast Symtoms: What to Report and What to Expect

Breast Symptoms

Call your doctor's office if you notice any of these:

A lump or thickened area in the breast or underarm
One breast getting larger, or a change in its shape
New pulling-in of the nipple (nipple turning inward), if that is new for you. Some women have always had one or both nipples invert, especially with stimulation. So don't freak out if this applies to you
Fluid leaking from the nipple on its own, especially if it is clear or bloody, comes from one breast, and comes from one spot
Skin changes: redness, swelling, dimpling like an orange peel, scaling or eczema-like rash on the nipple, or a sore that will not heal
New breast pain in one specific spot

Important: A screening mammogram is for women with no symptoms. If you have a symptom, you need a different, more detailed evaluation — do not simply wait for your next routine mammogram. Ask your healthcare provider if you should see a breast care specialist.

If You Feel a Lump

If you are 30 or older: you will usually get a diagnostic mammogram (3-D) plus an ultrasound of the area.If you are under 30: ultrasound is usually done first. If the lump does not seem worrying on exam, your doctor may suggest watching it for one or two menstrual cycles first. If it does not go away, imaging is done.If the imaging looks suspicious, the next step is a needle biopsy, where a small sample of tissue is taken with a needle, usually guided by imaging.If the imaging looks normal or benign but your doctor is still concerned, further evaluation is still done. Trust your instincts and speak up.

Hover to Read

If Your Nipple is Newly Turning Inward

If you have always had inverted nipples and nothing has changed, this is not a concern.

A new change does need imaging: ultrasound if you are under 30, or a mammogram plus ultrasound if you are 30 or older.

Hover to Read

If You Have Nipple Discharge with No Lump

Discharge that only comes out when you squeeze, or comes from several openings, is usually not a sign of cancer. You will be told to stop squeezing the breast and to report any discharge that happens on its own. If you are 40 or older, a mammogram is done if you have not had one in the past year.

Discharge that happens on its own, from one breast, from a single opening, and is clear or bloody does need testing: ultrasound if you are under 30, or a mammogram plus ultrasound if you are 30 or older. A breast MRI or a referral to a breast surgeon may follow.

Milky discharge from both breasts may be related to hormones or certain medicines rather than the breast itself, and may need blood tests. Some medicines can cause discharge, including certain mental health medicines, blood pressure medicines, opioid pain medicines, birth control pills, and estrogen.

Hover to Read

If You are Pregnant or Breastfeeding

Breast symptoms still need to be checked. Mammograms are safe during pregnancy and breastfeeding. Ultrasound is also used. MRI with contrast dye is not done during pregnancy but can be done while breastfeeding if needed. If you are breastfeeding, nurse or pump right before imaging — it makes the test more comfortable and more accurate. Some bloody nipple discharge can be normal in pregnancy, but if it happens more than once or twice, get it checked.

Hover to Read

What Follow-Up Looks Like After a Test

Normal or benign result: You go back to your regular screening schedule.
"Probably benign" result: This means the finding is very likely harmless, but your team wants to be sure. You will usually have a repeat exam and imaging at about 6 months, then again at 12 and 24 months. Report any change in between visits.
Suspicious result: Usually a needle biopsy can be done to find out what it is. Most biopsies turn out not to be cancer.
If a cyst is drained and the lump goes away with clear fluid, you return to routine screening. If the lump stays or the fluid is bloody, more testing is needed.
Getting your follow-up testing done on time matters. Delays can allow a cancer to grow. If you are having trouble scheduling an appointment or getting it covered, visit our Contact page and tell us how we can help.

Questions to Ask Your Health Care Provider

What risk group am I in, and why?
What is my breast density, and does it change my plan?
Should my family history be reviewed by a genetic counselor?
When should I have my next mammogram, MRI, or CEM?
Does it make any difference where I've had mammograms in the past or where I go now?
Are there medicines or other steps that could lower my risk?

You do not need a referral to schedule a screening mammogram. Medicare and most insurers allow you to book it yourself and we're here to help if you need us. Remember to reach out by visiting our Contact page. A real person will contact you to help.

Important Reminders

If you cannot have an MRI (for example, because of a metal implant, severe claustrophobia, or a reaction to the contrast dye), other options include contrast-enhanced mammography (CEM). A whole-breast ultrasound may be used if those are not available, but screening ultrasound finds fewer cancers than MRI, so it is not the first choice.
A note on thermography: This test is not recommended for breast cancer screening. There is no good evidence that it works.
Breast awareness simply means being familiar with how your breasts normally look and feel, so you notice when something changes — and then telling your doctor promptly. Some women find it helpful to check their breasts regularly. If you still have periods, the best time to check is at the end of your period in the shower. Breast awareness is part of every plan, at every risk level.

Breast Cancer

Resources

American Cancer Society: https://www.cancer.org/
Targetbreastcancer.org: https://www.targetbreastcancer.org
Women’s Health.gov: https://www.womenshealth.gov/

To view more breast cancer-related resources, visit our Resources page or click the button below.

Resources Page