Family matters
Personal and family medical histories help doctors better determine the risk of developing breast cancer
By Dr. Jennifer Park 10/29/2009
Several recent advances in screening for breast cancer make it more important than ever to understand your own risk for breast cancer.
Family history is one of the most important pieces of information that you can give your doctor. There is a hereditary breast and ovarian cancer syndrome for which genetic testing is available. Two gene mutations are tested for, called BRCA1 and BRCA2. About 3 to 5 percent of all cases of breast cancer are due to mutations in these genes.
You may be a candidate for testing for these gene mutations if you have any of the following red flags in either a first or second degree relative (which includes a parent, a sibling, a child of yours, or a biological aunt, uncle, niece or nephew): the combination of both breast cancer and ovarian cancer, an incident of breast cancer at age 40 or younger or among male family members at any age. Testing may also be warranted if there are multiple family members affected with breast cancer at any age.
Certain ethnicities are also considered at increased risk for BRCA1 and BRCA2, specifically those who are of Ashkenazi Jewish, French Canadian (Cajun) or Icelandic ancestry.
The ideal person to be tested for BRCA1 or BRCA 2 is the “affected individual,” meaning the person in the family who has the early onset breast cancer or ovarian cancer. This allows testing of family members to be more specific and less costly. If that individual is not available for testing, a patient can still get tested.
Since hereditary breast cancer syndromes account only for a small percentage of breast cancers, there are other tools used to measure one’s risk. These tools (computer software programs) take into account the age at which you first started having periods, the age at which you had a first live birth, any previous breast biopsies, and your current age. This information is then integrated to determine a lifetime breast cancer risk number (the percent chance of having breast cancer at any point in one’s life).
A screening mammogram is the standard test used for early detection of breast cancer. A new type of breast cancer screening with ultrasound called SonoCine (not yet FDA approved) is also available in some locations. This test can sometimes identify a cancer missed by a mammogram, particularly in women with “dense” breasts.
Breast MRI is the newest recommendation by the American Cancer Society for women at very high risk for breast cancer, meaning greater than a 25 percent lifetime risk. Breast MRI can also identify a difficult to diagnose pre-cancerous condition called DCIS. Screening MRIs are not recommended for women with less than 15 percent lifetime risk.
Other factors that may increase your risk for breast cancer include: increasing age, delayed childbearing or having no children, late onset menopause, postmenopausal hormone usage, obesity, and alcohol usage. Despite widespread concern, there is no proven increased risk for breast cancer among oral contraceptive users or caffeine drinkers. There is an increased risk for postmenopausal women on combination estrogen and progesterone but not for those on estrogen alone.
There are some lifestyle changes that can decrease your risk for breast cancer. These include limiting alcohol consumption, maintaining a healthy adult weight and regular physical exercise. Other factors that are associated with a lower risk for breast cancer include having children at a younger age and breast feeding for greater than six months.
Postmenopausal women can decrease their risk by shortening the duration of combination hormone therapy. For those considered at higher risk, medication can be prescribed to decrease risk. Monthly breast self-exams and routine clinical exams by your physician are also important.
Many advances have been made in breast cancer screening and prevention. The first step is to know your family history. Know the ages at which each member was affected by cancer and discuss this with your physician. He or she will determine if either genetic testing or advanced screening MRI is needed. If you have any lifestyle issues linked with a higher risk of breast cancer, try to change them to lower your risk, and keep in mind that early detection of breast cancer is the key to surviving!
The office of board-certified Ob/Gyn Dr. Jennifer Y. Park, a Fellow of the American College of Obstetricians and Gynecologists (FACOG), is at 625 S. Fair Oaks Ave., Suite 255, Pasadena. Call (626) 304-2626 or visit drpark@fowh.com or fowh.com.
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