Are You at High Risk of Breast Cancer?

By W.C. Dandridge Jr., MD, MBA, FACS
Chief of Surgical Services, Mercy Hospital Joplin

Women are showing a decrease in the death rate for breast and ovarian cancer, but a further decrease can be accomplished for hereditary breast cancers and for those who are at higher risk for breast cancer than the general population because of a family history of either cancer.

Breast cancer is divided into two categories: sporadic and hereditary. In sporadic breast cancer, an abnormal gene is acquired after birth and is not passed on to a woman’s children. Sixty percent of women diagnosed with breast cancer have this type.

Familial breast cancer means those who have a strong family history of breast cancer. Forty percent of women with breast cancer fall into this category, with about 10 percent to 15 percent having an identifiable genetic cause for their cancer.

Hereditary breast cancer is caused by an abnormal gene that is passed through the family and is present in genes passed to the offspring.
Genetic-related breast and ovarian cancer is inherited as an autosomal-dominant gene, which means the gene is passed on in half of the children of a parent with an abnormal gene. It’s carried in the X chromosome as the BRCA 1 and BRCA 2 genes. Just because a woman inherits the gene doesn’t guarantee she will get breast cancer; however, it does increase the risk up to 80 percent during her lifetime.

Women who do not have breast cancer still may be at higher risk and should consider being evaluated for genetic testing if they have any of the following:

• Two or more relatives with breast cancer.
• A relative with two breast cancers.
• Any male member of the family with breast cancer.
• A direct female relative with breast cancer less than 45 years of age.
• A relative who is positive for a breast cancer gene.
• Multiple family members with ovarian, pancreatic, colon, prostate or thyroid cancer.

A woman should have genetic testing if she has a history of breast cancer and any of the following:

• Breast cancer at less than 50 years of age.
• Breast cancer at less than 60 years of age and a close female relative with breast cancer.
• Triple negative breast cancer at less than 60 years of age. This diagnosis means the offending tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative.
• A male relative with breast cancer.
• A close relative with ovarian cancer.
• Anyone in the family who tests positive for a breast cancer gene.

An inherited breast and ovarian cancer gene is detected with a blood test, with results available in four to six weeks. The test covers 21 specific genes, including the BRCA 1 and BRCA 2 genes and other genes that are known to increase breast and ovarian cancer risk.

If a member of the family needs to be tested, the best person to test is someone who has had breast cancer. That way, if the test is negative, the cancer is not caused by an inherited genetic abnormality. Results should be thoroughly discussed with a physician or genetic counselor about whether the test is positive or negative.

If a woman tests positive, she should discuss her options of reducing the risk of getting breast cancer. This may include close surveillance, risk-reduction medication, removal of both breasts before cancer can form and removal of the ovaries. The option used will depend on the woman’s preference and circumstances.

If a women tests negative for BRCA genes, she still will need close follow-up because she remains at an increased risk of getting breast cancer due to a family history of the cancer.

Deaths associated with breast cancer have decreased for the last 10 years because of early detection and treatment. By identifying women who are at high risk and providing risk-reduction methods, the death rate and treatment should decline further.

W.C. Dandridge Jr., MD, MBA, FACS, is Chief of Surgical Services at Mercy Hospital Joplin and specializes in breast surgery for the Mercy Breast Center. Mercy Clinic General and Specialty Surgery, 100 Mercy Way, Suite 440, Joplin, Mo. 64804 and can be reached at 417-781-4404 or 417-556-3800. The Mercy Cancer Center can be reached at 417-782-7722.