While most women are aware that having a family history of breast cancer increases their risk of developing the disease, the fact remains that as many as 75% of women newly diagnosed with breast cancer do not have any specific risk factors, other than being a woman. Approximately one in eight women will develop breast cancer over her lifetime.
Many risk factors cannot be controlled, such as family history, age at menarche (first period), and age at first pregnancy. However many more risk factors can be controlled - knowledge is key! Lifestyle factors such as regular exercise, maintaining an ideal body weight, a diet low in saturated fat, and moderation in alcohol intake (3-6 drinks per week for women) will help reduce the risk of developing breast cancer.
Evaluation of your risk using a risk-assessment model may help put your concerns in proper perspective. While a risk-assessment model is not a crystal ball, many women overestimate their risk - a comprehensive review of the factors that you can and cannot change will help us develop a plan for surveillance and early detection that is appropriate for you. The most commonly used risk assessment model is the Gail Model, available from the National Cancer Institute Website. Unfortunately the Gail Model does not take into account 2nd degree relatives or age at diagnosis but it is a good starting point. Other models such as the Tyrer-Cusik and Claus are more detailed.
BrevaGEN is an exciting addition to the risk-assessment consultation. Unlike BRCA gene testing (see below) which is primarily for women with a strong family history of early breast cancer, the BrevaGEN test has been validated in Caucasian women, ages 35 and older. A genetic sample is taken using a cheek swab, and is tested for 7 different single nucleotide polymorphisms (SNPs) - variations in DNA known to be associated with elevated risk. The genetic result is combined with the Gail Model assessment to provide a 5 year and lifetime risk assessment. Unlike risk assessment computer models alone, the BrevaGEN result gives us important information about an individual patient’s risk of developing a breast cancer, and knowing that risk will allow us to develop a more tailored prevention, monitoring and testing program. The majority of insurance carriers do cover the test, and we are proud to be one of the few facilities in our area to offer this test to our patients. Patients found to be at increased risk may benefit from more intensive lifestyle changes as well as more detailed screening tests.
Depending on your specific family history, you may be a candidate for BRCA gene testing. BRCA stands for BReast CAncer Genes 1 and 2. A mutation in one of these genes will lead to a significantly increased risk of breast and/or ovarian cancer, as well as some other cancers. Using a saliva test, it can be determined if you are a carrier for one of these mutations - this information can be very important in determining the appropriate imaging and treatment options. There are many other genetic mutations that have been identified with may result in an increased risk of breast and other cancers besides BRCA 1 and 2, and testing for these mutations may also be appropriate depending on your family history. The National Cancer Institute has a comprehensive fact sheet that discusses additional information about BRCA gene mutations. In addition, national organizations such as F.O.R.C.E. provide support and education for patients with or at risk for hereditary breast and ovarian cancer.
When you are seen for a consultation, Dr. Attai will review your history and will discuss whether any of these testing methods is appropriate for you.