If Youre At High Risk - Risk Factors: Breast Cancer

Content provided by the Faculty of the Harvard Medical School

If you're at high risk

If you think you have a higher than average risk for breast cancer, your first step should be to see your doctor or a breast cancer specialist to evaluate your level of risk.

If you choose to go to a breast cancer specialist or a high-risk center for evaluation, the clinician is likely to use a computer program to help determine your level of risk. This program might be on the office computer or, in some cases, in a small, hand-held computer that looks like a calculator. The clinician will ask about your personal risk factors, such as family history of breast cancer and age of first menstruation, and enter this information into the computer.

One of the more common risk-assessment programs is known as the Gail Model, named after the doctor at the National Cancer Institute who developed it. Among the variables that are evaluated in determining risk are your age at menarche, your age at the time of your first birth of a child, certain characteristics seen in a breast biopsy, the number of biopsies that you have received , race, and the number of close first degree relatives that have breast cancer. Your clinician will express your results as a percentage, such as "Your risk is 2% for being diagnosed with breast cancer in the next five years." This example means that out of 100 women with the same risk factors, 2 will be diagnosed with breast cancer within 5 years. Ask your clinician to compare this figure with the risk of an average woman in your age group.

Another risk-assessment model is called the CASH model. It is especially helpful for a woman that has a first degree family member with breast cancer. Although it is designed for professionals, it can be used by anyone. See http://www.cancer.gov/bcrisktool/. Be sure to discuss the results with your doctor.

If you are at high risk, you have an added incentive to follow the recommendations for all women to minimize the chances of developing breast cancer, such as avoiding postmenopausal hormones and limiting alcohol use. Other steps to potentially protect your health may be suggested by your doctor, including:

• Have a mammogram every year. If you have a mother or sister with breast cancer, start having annual mammograms when you are 5-10 years younger than the age that family member was when the cancer was diagnosed, and no later than age 40. For example, if your mother was 41 when her breast cancer was diagnosed, begin your annual mammo­grams between ages 31 and 36.

• Schedule clinical breast examinations once or twice a year. The Cancer Genetics Studies Consortium, a working group of the Human Genome Project, recommends that women have clinical breast exams annually or semiannually, as mammograms fail to detect 10%-15% of cancers.

• Examine your breasts every month. Do a self-exam about seven days after your menstrual cycle begins. If you are no longer menstruating (or if your menstrual cycle is highly irregular), examine your breasts at the same time each month. Although the benefit of breast self-exams has not been documented, as a practice it may prove helpful, particularly in young women whose dense breasts may reduce the effectiveness of mammography.

• Consider genetic testing. If you have a family member with cancer that might stem from a mutation of BRCA1 or BRCA2, consider having a test to see whether you have the same mutation. If you do have the mutation, you are at especially high risk of developing breast cancer. Women in this group should have a mammogram and breast MRI annually plus a clinical breast exam every six months. However, if you test negative for these mutations, you have the same risk of developing cancer as the general population, even if someone in your family has a BRCA1 or BRCA2 mutation. If your test is negative, you should follow the same screening guidelines established by one of the national medical organizations.

The suggestions above are just that. They are not standard recommendations because studies have not conclusively shown them to be beneficial.

Last updated:	April 23, 2007