You’re right to think some people are at greater than average risk for breast cancer based on conditions that can be inherited. Although most breast cancers are random, family history and certain genetic markers are important considerations, in addition to your personal medical history. This article explains what this means from your perspective as a caretaker of your own health, and in your relationship with your primary care physician and partner in this effort.
While breast cancer is the most common malignancy diagnosed in women, it can occur in men as well. Your primary care physician will review your personal and family history in order to identify any known risk factors for breast cancer. A consult with a genetic counselor or breast cancer specialist, or additional imaging, may be recommended depending on your history.
Most actual cancers are caught through routine mammographic screening. The most important step you can take to manage breast cancer risk is to establish a relationship with a primary care physician, who will work with you to develop a screening plan specific to you.
Key considerations you should address with your physician are:
- Whether you are a candidate to begin mammographic screening prior to age 40. This will largely depend on evaluation of your specific risk factors. Keep in mind that while mammography involves a relatively low dose of radiation, radiation is still involved, so controlling the number of mammograms to which you are exposed is one consideration.
- What form of mammogram is best for you. Dense breast tissue may lead your physician to recommend mammographic imaging suited to these conditions, such as tomosynthesis (3-D mammogram).
- Your personal and family history of breast and other cancers. The more information you are able to obtain about family history, the better — and not just regarding breast cancer. A family history of ovarian, tubal or peritoneal cancer, and/or BRCA-1 or BRCA-2 gene mutation, are among the major factors used to determine your risk of developing breast cancer. And for female family members who had breast or ovarian cancer, your physician will hope to learn at what age the cancer was diagnosed.
- Your personal history. Please let your physician know if you have undergone a breast biopsy of non-cancerous breast lesions confirmed through biopsy, as well as any history of radiation therapy to the chest between ages 10 and 30. This information provides another basis to evaluate your personal risk category for developing breast cancer over your lifetime.
- Genetic testing as a step to obtain even more information about your risk category. Unlike mammography, genetic testing is not currently routine, and — again unlike mammography — cannot identify active cancer. Some genetic factors, such as the BRCA-1 and BRCA-2 genes, are known to be associated with a higher-than-average risk of developing breast cancer. Like personal and family history, the purpose of genetic testing is to provide information to guide you and your physician in developing a plan appropriate for you. If your primary care physician recommends genetic testing to help evaluate your risk, she will refer you to genetic testing and counseling resources. You should expect these resources to explain the testing process and results with you in detail, and you can look forward to further review with your physician once genetic information is part of the picture available to both of you.
Development of a screening plan customized for you will permit you and your physician to evaluate how best to manage your risk for breast cancer. That risk management partnership is an important part of your lifetime relationship with your doctor.