Cancer Risk Assessment

Sometime during their life most women will worry about breast cancer. The American Cancer Society (www.cancer.org) has noted that 1 out of 8 women will be affected by breast cancer. Here are several things you should know about breast cancer risk assessment:

Know your family history. Your Health Care Provider should regularly review your family's health history. If you are not aware of what your family history includes, it is very difficult to determine if you may be at a higher risk for breast cancer. A person should not only know what types of diseases are in their family but at what age a cancer or disease state was acquired. It would also be best to know what type of breast cancer affected your family member. In assessing breast history this is especially important.

In breast cancer risk assessment we find there are 3 different types of risk to consider: 1. General population risk. (This is where we find the majority of the risk). 2. Familial risk 3. Hereditary or genetic risk.

General population risks refers to no or very limited family history of breast or ovarian cancer.
Familial risk is when there is a moderate family history of breast or ovarian cancer.
Hereditary risk means that a genetic mutation has been found in a person in the family.

All women have BRCA 1 and BRCA 2 genes. These genes enable us to fight cancer cells. Genetic testing identifies a mutation or defect in the cancer fighting genes. This would put the person at greater risk for breast cancer since they are not able to fight off the cancer producing cells. Approximately 10% of breast cancers and 15% of ovarian cancers are caused by mutations in these genes. When a person carries a mutation in the BRCA 1 or BACA 2 genes it is refered to as a syndrome called hereditary breast and ovarian cancer (HBOC)syndrome. There is testing that can be done to determine if a person with a family history of breast or ovarian cancer has this syndrome. The sample can be obtained by saliva or blood. www.myriad.com

Most women will not need to be tested for a hereditary risk. Only women with a family history of breast and/or ovarian cancer may need to be evaluated in more detail. The following are general risk factors that you should tell your health care provider.
Is there a family history of breast cancer?
What age was the cancer diagnosed?
Is there any famiy history of ovarian cancer?
Has any male member of you family had breast cancer?
Do you have an Ashkenazi jewish ancestry?
Does any family member have a known BRCA mutation?
Has anyone in your family had a triple negative breast cancer?
Is there a family history of pancreatic cancer with breast or ovarian cancer
in the same person or on the same side of the family?
Is their a family member that has had multiple breast cancers?

Many women are not certain why they would want to know their breast cancer risk. It would be important to know your cancer risk to develope a medical management plan specific to the individual. This may include more or even less survillence or interventions.

For the general population it is best to get an annual mammogram starting by 40 years of age. It is recommended to have a yearly clinical breast exam and to learn self breast exams. The general population risk for breat cancer is up to 11% by age 70.

Familial risk recommendations may mean annual mammogram and breast exams but with health history information it may be necessary to start this earlier than age 40. If a women has >20% lifetime risk of breast cancer it may be necessary to do a mammogram and an MRI on an annual basis alternating every 6 months.

Hereditary risk would indicate an increase in surveillance. Women that have a BRCA 1 or BRCA 2 mutatation may have up to an 87% risk for getting breast cancer by the age of 70. Starting mammograms and MRI at a younger age (usually age 25) would increase the chance of finding a cancer at an early, treatable stage. Other options may be considered such as surgical intervention (masetectomy, that is, removal of breast breast(s)and/or removal of the ovaries). Medical treatment with Tamoxiphen would be another option to consider. Trans vaginal ultrasounds may be necessary to monitor the ovaries.

Review your family history today!