Family History of Breast Cancer—What Does It Mean?
by Dr. Elizabeth Kent
Published in The Neosho Daily News
Monday, October 5, 2009
With one in six women developing breast cancer in her lifetime, many people have a family member who has or has had breast cancer. What does this really mean? How much does an “average family history of breast cancer” affect an individual’s personal risk of getting the disease? How should this affect screening? Are there any preventative steps a woman can take? When should a person or family be tested for a “breast cancer gene”?
It is well established that having a family history of breast cancer matters, likely because factors such as breast tissue characteristics and internal estrogen exposure get passed down through generations. With one first-degree relative (i.e., mother, sister, or daughter) with breast cancer, a woman’s risk of getting breast cancer almost doubles. With two first-degree relatives, the risk triples. Recommended screening for women with a family history is still annual mammograms beginning at age 40, earlier if the relative was diagnosed at a young age.
While a woman cannot change her family history, she can modify her risk of breast cancer. For instance, we know daily alcohol use, even one drink per day, can increase a woman’s risk of developing breast cancer. Choosing to avoid or minimize certain hormone replacement therapies after menopause can also cut down a woman’s risk of breast cancer. In addition, two preventative medications are available for women at high risk. With the help of primary care providers, women can make informed choices appropriate for their individual risk.
Specialized help may be needed to decide if a person should be tested for a breast cancer gene. The two most common genes that predispose to breast cancer are BRCA1 and BRCA2. These genes affect men, as well as women, and can also increase the risk of ovarian, prostate, and pancreatic cancers. These genes are not common—only one in 1,000 people carry one of these genes. But for individuals and families who do carry the gene, the risk of getting these cancers is much higher than for people with an “average family history,” up to an 85 percent lifetime risk of getting breast cancer and up to a 45 percent risk of ovarian cancer. Recommendations for screening and prevention are therefore much different and can dramatically cut down the risk of getting cancer for people with the gene.
Testing for this gene should not be performed on all people with a family history of breast cancer. The decision should be made with the assistance of a provider trained in genetic counseling. This crucial counseling prior to testing helps ensure testing is indeed appropriate and patients understand the medical, psychological, and financial ramifications of the results.
Knowing your family history of breast cancer, and sharing it with your healthcare providers, is crucial.
About Elizabeth Kent, MD
Dr. Kent specializes in oncology/hematology at Freeman Cancer Institute. Dr. Kent is board certified in oncology. For more information on Freeman Cancer Institute, please call 417.347.4000.