There is no doubt that breast cancer can run in families, so it's likely that there is a hereditary factor. It is important to note that only about 10 percent of women diagnosed with breast cancer have a family history. Just because one of your relatives had breast cancer does not mean you are absolutely fated to develop it. In fact, with today's advanced diagnostic screening and testing options, many women feel empowered to make proactive and informed decisions about how to manage their breast health.
Women who have a strong family history of breast cancer are encouraged to find a comprehensive breast center where experienced breast specialists can guide you about decisions regarding:
- Genetic testing
- High-risk evaluation and monitoring
- Screening schedules including digital mammography and clinical breast exams
- Double preventive (prophylactic) mastectomies with reconstructive breast surgery
- Hormonal therapy medications designed to prevent the development of breast cancer
Managing your Breast Health Options
We offer a safe and supportive environment where you can ask questions and get the best answers for you. Every woman's decision about how to handle her risk of developing breast cancer is managed with sensitivity and an understanding about the complexity of these decisions.
Guidelines for Genetic Testing for Breast Cancer
If there is a strong history of breast and/or ovarian cancer in your family, you may want to consider being tested for the BRCA1 or BRCA2 genetic mutation. But do understand that regardless of test results, there's no absolute way to predict the future of your breast health. Genetic screening for breast cancer just gives you one more piece of information to help you make a decision.
If you test positive for a genetic mutation, it is not a given that you will develop breast cancer: the risk ranges from 65-80 percent. The risk of ovarian cancer is 40 percent. There are women with significant family history of breast cancer who test negative, but this doesn't guarantee they will not develop breast cancer. There are also cases where the woman tests positive, even though she has no family history of the disease.
Families most likely to have an inherited form of breast cancer are those in which there are:
- Several cases of breast cancer occurring before menopause through multiple generations of the same side of the family
- Cancer diagnosed in both breasts
- A male with breast cancer
- Family history of breast and ovarian cancer in multiple relatives on the same side of the family
The BRCA1 and BRCA2 genetic mutations account for only half of all families with hereditary breast cancer. Scientists are likely to find many more genes associated with increased risk for breast cancer. Therefore, current testing may not be advanced enough to find the exact genetic alteration in a particular family.
All women should undergo genetic counseling prior to testing. Decisions made from test results can be life altering, and there are also ramifications for other family members (siblings, children) since someone with a genetic mutation has about a 50% chance that her children also will test positive.
The test is a simple blood test that is covered by most insurance companies. There is one lab in the U.S. who performs the analysis so on average, results take 21 days. If you have a family member who has tested positive, the lab can look specifically for that gene alteration. In these cases, results may take one week.
Guidelines for Breast Cancer Screening
For women who have a first-degree relative (mother, sister, daughter) with breast cancer:
Breast imaging screening should begin five years before the age the relative developed the disease, or at age 40, whichever is the lower number. For example, if your mother was diagnosed when she was 35, you should begin screening when you are 30.
For women whose relatives were diagnosed at early ages, and for women with a BRCA1 or BRCA2 mutation:
Screening is recommended to begin 10 years before the youngest relative was diagnosed. So if your mother and her sister were diagnosed at 35 and 32, you should begin screening at 22. Screening in young women may involve ultrasound or MRI as opposed to mammography, since breast tissue is very dense in young women.
Guidelines for Elective Surgical Options
Making the decision to have an elective preventive double mastectomy and removal of the ovaries is personal and should be based on many life factors. You must balance where you are in your childbearing years, what your future choices may be, and whether you would prefer to follow a rigorous screening schedule instead of making such a life-altering choice.
Whatever your decision, we encourage you to make an informed choice. If you do elect to have a preventive double mastectomy, our breast specialists will guide you in the appropriate breast surgery reconstruction to help restore your body image after treatment.
If you are interested in discussing ovary removal surgery (oopherectomy), we will refer you to one of our gynecological oncologists.