IBCORA Project

Improving Breast Cancer Outcomes in Rural Appalachia

We are dedicated to the fight against breast cancer through education, resources, and community support. Our Goldilocks Screening Plan, the heart of IBCORA, is how we are in the fight with you. This initiative was created with a clear mission: to ensure women in rural communities have access to life-saving, personalized screening strategies. Learn more below.

A Critical Healthcare Message from IBCORA Goldilocks

Click the video to watch IBCORA Goldilock's important message. Click the link below to take our free Genetic Pre-Screening Test.

Free Genetic Advice

Let's Assess Your Risk

Breast cancer is the most common cancer in women, and early detection greatly improves treatment success. Screening frequency and type depend on your risk level. Every woman should complete a breast cancer risk assessment by age 25. Below we will walk you through each level of risk. If you are identified as anything other than low risk, please complete the embedded Tyrer-Cuzick risk assessment. Based on your results, follow the recommendations for your assigned risk category. If you qualify for testing or need assistance, an AMP Patient Navigator can provide support and help coordinate screening and genetic testing at your preferred facility.

You are considered average risk if you have:

- No known gene mutations linked to breast cancer (such as BRCA1 or BRCA2)

- No first-degree relatives (mother, sister, daughter) with breast cancer, or only a limited family history

- No prior chest radiation between ages 10 and 30

- No prior breast biopsies showing atypical cells

- A lifetime breast cancer risk below 15%

You are considered high risk if you have:

- A lifetime breast cancer risk of 20% or higher (based on a risk model that includes detailed family history)

- A known gene mutation that increases breast cancer risk (such as BRCA1, BRCA2, PALB2, TP53, or others)

- A first-degree relative with a known high-risk gene mutation (even if you have not been tested yourself)

- A history of radiation therapy to the chest between ages 10 and 30 (for example, treatment for Hodgkin lymphoma)

You may be considered moderate risk if you have:

- A lifetime breast cancer risk between about 15% and 20%

- Dense breast tissue on mammography (heterogeneously or extremely dense)

- A prior breast biopsy showing atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS)

- A 5-year risk of invasive breast cancer of 1.7% or higher (calculated by your doctor)

- Ages 25–39: See your doctor every 1–3 years for a breast health check-up. Get to know what is normal for your breasts and report any changes right away.

- Age 40 and older: Get a mammogram every year. Both the ACR and NCCN recommend annual mammograms starting at age 40. A 3D mammogram (called tomosynthesis) is preferred when available because it finds more cancers and leads to fewer callbacks.

- When to stop: There is no set upper age limit. Continue screening as long as you are in good overall health and would be willing to undergo treatment if cancer were found. Consider stopping if life expectancy is less than 10 years.

A note about dense breasts: If your mammogram report says you have dense breast tissue (either "heterogeneously dense" or "extremely dense"), talk to your doctor. Dense tissue makes it harder for mammograms to find cancer and also raises your risk slightly. You may need additional screening — see the "Moderate Risk" section below.

- Doctor visits: Every 6–12 months for a breast health check-up, starting when you are identified as being at increased risk.

- Mammograms: Every year (with 3D/tomosynthesis when available), starting when you are identified as being at increased risk.

- Breast MRI: Your doctor may recommend a yearly breast MRI in addition to your mammogram, especially if you have atypical biopsy results or extremely dense breasts. The ACR recommends MRI for women with dense breasts who want supplemental screening, and for women with atypia or LCIS — particularly if other risk factors are also present.

- If you cannot have an MRI (for example, due to a pacemaker or claustrophobia), alternatives include contrast-enhanced mammography (CEM), molecular breast imaging (MBI), or breast ultrasound.

- Risk reduction: Ask your doctor about medications or lifestyle changes that may lower your risk.

- Doctor visits: Every 6–12 months for a breast health check-up, starting as soon as you are identified as high risk. Your doctor may refer you to a genetic counselor and/or a breast specialist.

- Mammograms: Every year (with 3D/tomosynthesis), starting no later than age 40 — or 10 years before the youngest family member was diagnosed with breast cancer, but not before age 30.

- Breast MRI: Every year, starting no later than age 40 — or 10 years before the youngest family member was diagnosed with breast cancer, but not before age 25. The ACR recommends annual MRI beginning at ages 25–30 for women with genetic mutations, a calculated lifetime risk of 20% or more, or a history of chest radiation.

- Many experts suggest alternating your mammogram and MRI every 6 months (for example, mammogram in January, MRI in July) so that you are being checked every 6 months.

- If you cannot have an MRI, alternatives include contrast-enhanced mammography (CEM), molecular breast imaging (MBI), or breast ultrasound.

- Genetic counseling: If you have not already had genetic testing, ask your doctor about a referral to a genetic counselor.

- Risk reduction: Talk to your doctor about medications (such as tamoxifen or aromatase inhibitors) or surgical options that may significantly lower your risk.

Are you at Moderate or High Risk?

IBIS Breast Cancer Risk Evaluation Tool

Click this link to take the free IBIS Evaluation test

NCI Breast Cancer Risk Assessment Tool

Click this link to take the free NCI Assessment

Other Resources: American College of Radiology: acr.org | National Comprehensive Cancer Network: nccn.org

Meet Goldilocks

To bring this approach to life, meet Goldilocks, a 38-year-old virtual breast cancer survivor. Her story shows how small, proactive steps can make a life-changing difference and that is exactly what we are enacting through The Goldilocks Screening Plan. Read more about Goldilocks, her family, and The Plan below.

The Screening Plan

The Goldilocks Screening Plan is an important component of our first healthcare improvement project, IBCORA: Improving Breast Cancer Outcomes in Rural Appalachia. IBCORA was created with a simple but powerful mission: to ensure that women in rural communities have access to the same life-saving, personalized screening strategies available anywhere else.

Below, we’ll introduce you to Goldilocks, our 38-year-old virtual breast cancer survivor. Through her story, you’ll see how, with just minimal effort, she spared her family and herself a tremendous amount of avoidable anxiety. When Goldilocks learned about her family’s cancer history, her 58-year-old mother’s battle with ovarian cancer and her 78-year-old grandmother’s bilateral breast cancer, she made the decision to seek genetic advice. That single decision may have saved her life.

Imagine Goldilocks sitting at the family dinner table with her mother and her grandmother, who sits proudly at the head of the table. Three generations of women, each touched by cancer in different ways, but united by the knowledge that understanding your risk can change everything. Their story could be your story. You and your family deserve the same chance Goldilocks gave hers.

We’ll show you how.

Learn More About Screening

Meet the Family

IBCORA Project's Story

IBCORA Goldilocks

Hover to Read Story

IBCORA Goldilocks is a 38 year old light brown skinned woman with curly blond hair. She is married, and has 3 children, Ibcora Future18, Bright Future10 and Dandy Jr 8. Her late husband, Dandy Future was killed 6 years ago in a mining accident. Ibcora and her family live in McDowell County, WV and she has a bit of a WV accent. She is an elementary school teacher and was diagnosed with a very small triple negative invasive breast cancer 2 years ago. Her breast cancer was found on her initial mammogram which she got upon finding that she was in the high risk category for developing breast cancer, following free genetic counseling and genetic testing. The genetic counseling was ordered by her PCP after learning that her 58 year old mother was diagnosed and treated for ovarian cancer at 55 and her 78 year old grandmother has a history of a first breast cancer at 60 and a second on the other side at 70. Ibcora Project had neoadjuvant chemotherapy followed by a lumpectomy, sentinel lymph node biopsy and radiation therapy. She has completely recovered, is back to work teaching and wants to make sure women 25 and older find out about the Goldilocks Screening Plan, which she believes probably saved her life.

IBCORA Nanay

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IBCORA Nanay is Ibcora Project’s 58 year old mother who is a nurse at the local hospital. She is a 3 year survivor of ovarian cancer and wants everyone to know that ovarian cancer is one of those cancers that is often not discovered in its earliest stage. Because there currently is no generally recommended screening test in women who are not found to be genetically predisposed, women need to be mindful of pelvic symptoms and know that a family history of ovarian cancer should alert other family members about potential genetic predisposition for cancer. Fortunately, her ovarian cancer is the very reason her daughter got her genetic counseling, genetic testing and a mammogram after finding she was in a high- risk category for breast cancer. With so much cancer in the family, Ibcora Nanay really appreciated getting her Goldilocks Screening Plan and makes sure she gets her 3D mammogram every year. She remembers how worried she was when “her baby” was diagnosed with breast cancer.

IBCORA Future

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IBCORA Future is Ibcora Project’s 18 year old daughter. For a girl who lost her father and then watched both her granny and her mom have very serious health problems, in rapid succession, she’s remarkably well adjusted and mature. She’ll be starting college in the fall and wants to become a nurse. She remembers how scared she was when her granny had her ovarian cancer and the next year her mother was diagnosed with breast cancer. She’s determined to help spread the word about finding out about genetic testing and the Goldilocks Screening Program.

Alfie Project

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Alfie Project, called A.P. by his friends, is Goldilocks 45 year old husband. He’s a self-employed carpenter. A.P. feels incredibly relieved now that Goldilocks is “back to normal”. He remembers just how freaked out he was even after the doctor told them how lucky they were that “we caught her cancer so early”. Although A.P. looks like a big, tough guy, he couldn’t imagine what it would be like losing Goldilocks and raising the kids without her. It really got him thinking, so he got his colonoscopy this year when his doctor said “It’s time for you to get a screening colonoscopy, just to play it safe.” A.P. tells all his buddies not to let their wives give any excuse not to check out the Goldilocks Screening Plan. He was so-o-o lucky. So, what’s it all about Alfie? “Just Do It!"

IBCORA Lola

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IBCORA Lola is Ibcora Project’s 78 year old grandmother. Although she’s had breast cancer in both breasts, she’s otherwise “fit as a fiddle”. She learned about the Goldilocks Screening Plan when her granddaughter was diagnosed with breast cancer and although she is older than the cutoff age for screening at the clinic, she’s going to continue getting her mammogram every 2 years. Afterall, she’s really the matriarch of the family and even helps take care of her 98 year old mother who lives with her. Her message to the younger generation of women: “Don’t be stupid honey. An ounce of prevention is worth a pound of cure. Find out if you need genetic testing. After all cancer around here is “bout as common as an old shoe.”

I. Frenly

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I. Frenly is Goldilocks’ 42 year old best friend. She works for a local insurance agency. I. started screening when Goldilocks did and found she was at average risk but doesn’t understand why any woman would want to wait until 50 to get a mammogram. I. plans to get her mammogram once a year without fail! After all, she wears a seat belt every time she drives her car. She doesn’t smoke or drink and gets a physical checkup once a year as part of her health plan. To say nothing about the fact that her friend, Goldilocks, is living proof of the wisdom of the Goldilocks Screening Plan. I. wants to play it safe. She’s got too many people who depend on her.

Important Reminders

Risk can change over time. Your risk level should be reassessed periodically, especially as you age or if new family members are diagnosed with cancer.
Know your breasts. Get familiar with how your breasts normally look and feel. If you notice any changes — a lump, skin dimpling, nipple discharge, or anything unusual — contact your doctor right away. Do not wait for your next scheduled screening.
Ask about your breast density. After every mammogram, you should receive a letter that tells you whether your breasts are dense. If they are, ask your doctor whether you need additional screening.
Screening is not one-size-fits-all. These are general guidelines. Your doctor will work with you to create a screening plan that fits your personal situation.