A large percentage of my practice as a breast surgeon is devoted to screening and preventative care for breast cancer. There are many risk factors for breast cancer that can be changed, but one constant is family history. There is just no changing who you came from! Therefore, if you have a history of breast cancer in the family, there are some important considerations in order to assess your risk. The two most important questions when reviewing family history are “Who and How old?”
First-degree relatives are people who are directly blood-related to you like parents, siblings and children. These people affect your risk the most. Each person with breast cancer who is directly related to you increases your risk by about 6% points. Relatives like grandparents, cousins, aunts and uncles have a minimal impact, unless they are on the father’s side or are several in one family. Multiple generations of breast cancer in one family is a strong indicator of increased risk and may indicate a genetic cause for the cancers.
The next question to ask is, “How old was each person when they were diagnosed with breast cancer?” Breast cancer becomes more common as women age. In elderly women, it is less likely to be a result of a genetic mutation than in pre-menopausal women. Is there a pattern of each person getting cancer at a younger age? This type of pattern, as well as breast cancer below the age of 50, can indicate a possible genetic link.
The most common genetic abnormality resulting in breast cancer is the BRCA mutation. It is the only one for which there is a commercially available test. Most insurance carriers will pay for the test if criteria are present. This mutation results in a dramatically higher risk of 80-90% compared to those with only a familial risk of 20-30%. Fortunately, this is a rare cause of breast cancer, accounting for less than 10% of all cases. If you have breast cancer in the family, review your history and risk factors with your physician to determine your level of screening and surveillance.
Kelly S. Dempsey, MD