Diethylstilbestrol Exposure In Utero
Diethylstilbestrol, known as DES, was used clinically to prevent complications of pregnancy. In the late 1960s, an unusual occurrence of a rare cancer of the vagina among young women, called clear cell adenocarcinoma , was observed and subsequently linked to their intrauterine exposure to DES and in 1971, DES was removed from the market by the US Food and Drug Administration. However, 5 to10 million pregnant women and babies had been exposed to the drug. DES daughters have been found to have an increased risk for late breast cancer .
Epidemiology Of Breast Cancer
Breast cancer is the most common type of cancer diagnosed in women, comprising 30% of all womens cancer diagnoses in the United States. The American Cancer Society estimates that 281,550 new cases of breast cancer will be diagnosed in women in 2021 . After lung cancer, breast cancer is the second leading cause of cancer-related death in women, accounting for 15% of cancer-related deaths.
The incidence of breast cancer has consistently outpaced the incidence of all other cancers in women in the US. In 2014-2018, the incidence rate of female breast cancer in the US was 129.1 per 100,000 population. Of note, the incidence of invasive breast cancers decreased between 1999 and 2004, which coincides with and is possibly attributable to better adherence to recommended screening mammography for the general population of women, as well as decreasing use of menopausal hormone replacement therapy .
Worldwide, breast cancer is the leading cause of cancer death in women. Although the United States and Western Europe have a five-fold higher number of new cases of breast cancer compared with Africa and Asia, since 1990, the death rate of breast cancer has declined by 24% in the United States . This may be due to increased use of screening mammography and of adjuvant chemotherapy.
What Are The Current Genetic Counseling And Testing Guidelines For Women At High Risk For Breast Cancer
The ACS recommends genetic testing for women at high risk, as defined above, to look for mutations in the BRCA1 and BRCA2 genes . Although testing can be helpful in some situations, providers need to weigh the pros and cons with the patient. The ACS strongly recommends that women first talk to a genetic counselor, nurse, or doctor who is qualified to explain and interpret the results of these tests.
The U.S. Preventive Services Task Force recommends that women who have one or more family members with a known potentially harmful mutation in the BRCA1 or BRCA2 genes should be offered genetic counseling and testing. Women with an identified increased risk should be referred to a genetic counselor, who can further evaluate the risk based on family history, discuss the pros and cons of testing, and arrange for BRCA testing if the patient is ready to proceed.
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What About Screening For Breast Cancer
Evidence clearly indicates that women between the ages of 50 and 69 should have a mammogram every two years. Talk to your health care provider about the organized breast screening program in your province or territory. If you are 40-49 years of age or aged 70 or older, you are encouraged to discuss the benefits and limitations of mammography with your health care provider.
The booklet âInformation on Mammography for Women Aged 40 and Older: A Decision Aid for Breast Cancer Screening in Canadaâ is available on the Public Health Agency of Canada – Decision Aids website.
Hboc Case Study Cme Trainingrisk Assessment Tools For Women At High Genetic Risk For Breast And Ovarian Cancer
Identifying individuals at increased risk for developing a hereditary cancer is the critical first step in the process of reducing the incidence of some cancers. Health care providers can use the following risk assessment tools, decision aids, and resources to identify and manage their patients who may be at high risk for hereditary breast and ovarian cancer. Providers can also use the tools to increase their understanding of the risk factors that put women at high genetic risk for breast and ovarian cancer.
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Other Breast Cancer Risk Assessment Tools
Some tools, such as the Claus model, use family history to estimate breast cancer risk. Such tools can be used for women who have one or more relatives with breast cancer, or one or more relatives with ovarian cancer.
Other tools, such as IBIS and BOADICEA, use family history and other factors to estimate breast cancer risk.
The BWHS Breast Cancer Risk Calculator tool is based on data from Black women in the U.S. The tool uses a womans personal and family health history as well as her reproductive history to estimate her breast cancer risk.
Limits Of The Breast Cancer Risk Assessment Tool
The Breast Cancer Risk Assessment Tool does not use all the known risk factors for breast cancer to assess risk.
The tool also does not give a good risk estimate for some women, including those with a :
The original model was based on data from white women with data from the National Institutes of Healths Surveillance, Epidemiology, and End Results Program data. The tool can now estimate risk for:
- Black women, using data from the Contraceptive and Reproductive Experiences Study and SEER data
- Asian and Pacific Islander women in the U.S., using data from the Asian American Breast Cancer Study and SEER data
- Hispanic women, using data from the San Francisco Bay Area Breast Cancer Study, the California Cancer Registry, the California SEER Program and SEER data
The model may not work as well for other racial and ethnic groups.
Visit the National Cancer Institute website to learn more about the Breast Cancer Risk Assessment Tool.
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Breast Cancer Surveillance Consortium Risk Calculator
The Breast Cancer Surveillance Consortium Risk Calculator was developed and validated in 1.1 million women undergoing mammography across the United States, of whom 18,000 were diagnosed with invasive breast cancer. The BCSC Risk Calculator has been externally validated in the Mayo Mammography Health Study. In 2015, the BCSC risk calculator was updated to include benign breast disease diagnoses and to estimate both 5-year and 10-year breast cancer risk.
The Breast Cancer Risk Assessment Tool
The Breast Cancer Risk Assessment Tool allows health professionals to estimate a woman’s risk of developing invasive breast cancer over the next 5 years and up to age 90 .
The tool uses a womans personal medical and reproductive history and the history of breast cancer among her first-degree relatives to estimate absolute breast cancer riskher chance or probability of developing invasive breast cancer in a defined age interval.
The tool has been validated for white women, black/African American women, Hispanic women and for Asian and Pacific Islander women in the United States. The tool may underestimate risk in black women with previous biopsies and Hispanic women born outside the United States. Because data on American Indian/Alaska Native women are limited, their risk estimates are partly based on data for white women and may be inaccurate. Further studies are needed to refine and validate these models.
This tool cannot accurately estimate breast cancer risk for:
- Women carrying a breast-cancer-producing mutation in BRCA1 or BRCA2
- Women with a previous history of invasive or in situ breast cancer
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Breast Cancer Risk Calculator
To create a more personalized breast cancer assessment, with your SmartMammTM Princeton Radiology calculates your lifetime risk of developing breast cancer based on the Claus risk assessment model. The Claus model, derived from the Cancer and Steroid Hormone Study, calculates the lifetime risk for breast cancer based on the age at diagnosis of first and second degree relatives with a history of breast and ovarian cancer. The American Cancer Society recommends the use of a risk assessment model based on genetic information in order to decide if the patient is considered high risk for developing breast cancer when compared with the general population.
Instructions: To calculate your risk score please use the drop-down boxes to indicate your age and the ages of your relatives at the time of diagnosis for breast or ovarian cancer. If more than 2 relatives of the same type were diagnosed, please use the youngest ages of diagnosis. If relative is a half-sister, please enter as an aunt. Once all entries have been made, click the Whats my risk? button in the center of the screen.
What Can I Do
Be proactive. Increasing your awareness and knowledge may help reduce your risk of developing breast cancer. Take action on your lifestyle risk factors. Know your body, watch for changes, and contact your health care provider with any questions or concerns about breast health and breast cancer prevention, early detection and screening.
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Talking With Your Health Care Provider About Your Risk Of Breast Cancer
If you have questions about your risk of breast cancer, talk with your doctor, nurse or other health care provider.
Your family health history plays a role in your breast cancer risk. Before you meet with your health care provider, its helpful to collect information about your family health history.
Information on any cancers diagnosed in both the women and the men in your family will be helpful in assessing your breast cancer risk.
If you are considering genetic testing to learn if a family history of cancer is due to an inherited gene mutation related to cancer risk, talk with your health care provider or a genetic counselor. They can help you decide if genetic testing is right for you and your family.
Learn more about family history of breast cancer and breast cancer risk.
My Family Health History Tool
|My Family Health History tool is a web-based tool that makes it easy for you to record and organize your family health history. It helps you gather information that will be useful as you talk with your family members, doctor or genetic counselor.|
Add To Your Health Tool Kit
Wondering how to reduce your risk of breast cancer? Like having a mammogram or smear test, personalised breast cancer risk assessment is an important tool to help manage your health.
A BRRISK assessment reveals your personal risk of developing breast cancer. If youre at increased risk, there are steps you can take to manage this.
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What Others Say About Brrisk
“Overall I think this should be really helpful for women to sort out their risk – especially from the viewpoint that when you go to a surgeon or whoever to discuss your risk. A lot of it is not retained and its great to have an objective report you can refer to and think about subsequently.”
Helen – Doctor / BRRISK user
Finalized Risk Assessment Tool
The prior version of the computer-based risk assessment tool inspired the development of five primary pages. Each page allowed the participant to build an increasingly nuanced understanding of their risk and ways of mitigating their risk. Following iterative initial user testing with the multidisciplinary advisory board and visual/software changes to incorporate their feedback, the five primary pages developed were:
My risk snapshot: Reviews risk calculation inputs, as provided by participants in a WISDOM Study Breast Health Questionnaire, that are used to calculate both the Gail and BCSC scores. For each input, the page provides the user-submitted information for age, race, family history, breast biopsy history, and breast density. The page also explains the WISDOM Studys personalized screening recommendation, risk calculations, and polygenic risk score.
My risk report: Uses both natural frequencies and icon array diagrams to provide the risk of developing breast cancer versus an average woman of the same age and race/ethnicity. The participant can toggle between 5-year, 10-year, and lifetime risks, or compare all of them simultaneously .
Fig. 1: My risk report.
This primary page compares a participants five-year, ten-year, and lifetime risk of developing breast cancer in comparison to an average woman of the same age and race/ethnicity.
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Q3 What Does It Mean To Have Dense Breast Tissue And Why Does It Matter For My Tyrer
Breast cancer research and advances in risk assessment have shown that having dense breasts is a contributing factor in determining a womans risk of breast cancer. Dense breast tissue refers to the appearance of breast tissue on a mammogram and the makeup of supportive and fatty tissue in the breast. The more fatty tissue, the less dense the breast is. Dense breast are common and can be caused by simply being younger, having a lower body mass index, or taking hormone therapy for menopause researchers are still studying why some women have dense breast and other do not. Non-dense tissue appears dark and transparent, whereas dense breast tissue appears as solid white area on a mammogram the solid white area can make it hard for radiologists to accurately analyze the image with a mammogram, so your provider may recommend supplemental imaging, like a breast ultrasound or other recommendations, to ensure no cancers are missed. Having dense breast alone is not cause for concern, and you should speak with your doctor about your breast density and how it affects your risk status.
Q9 I Am In The High Risk Category Is There Anything I Can Do To Reduce My Risk Of Being Diagnosed With Breast Cancer
You should speak with your doctor about your specific circumstances to determine if there is anything you can do to lower your risk. In some cases, your doctor may recommend lifestyle changes, and in higher risk cases, there are risk lowering drugs and interventional surgery options. It is important, however, that your doctor make the appropriate recommendations.
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Q8 I Am In The High Risk Category Does This Mean I Will Definitely Develop Breast Cancer
No, being high risk just means that when statistically compared to other women, your chances are higher, sometimes only slightly higher. It is completely understandable to be concerned about your high risk status, but early detection is our best tool against breast cancer. By identifying your risk, your doctors can provide you with a personalized screening plan and/or risk reduction options.
How To Interpret Your Estimated Breast Cancer Risk
The Breast Cancer Risk Assessment Tool was designed to be used by health care providers. So, if you use the tool on your own, it may be hard to understand the results and use the information to make decisions about your care.
If you have questions about your breast cancer risk based on the results of this tool, talk with your health care provider.
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What Are The Risk Factors
Risk factors are conditions that may increase the chance of developing breast cancer. It is important to understand that most women will have some of these risk factors. Having one or more risk factors does NOT mean you will be diagnosed with breast cancer. In addition, many women who develop breast cancer have no obvious risk factors. Why some women develop breast cancer while others do not is not fully understood.
Generally recognized risk factors for breast cancer are listed below.
Ethics Approval And Consent To Participate
The requirement for informed consent for chart review portion of this study was waived due to retrospective nature of the data. Prior to the participation in the study, resident physicians were provided with an Institutional Review Board-approved written print-out discussing the methodology of the study, the voluntary nature of participation including the option to withdraw from the study at any point, and the contact addresses for further questions and concerns. Since participation into the study and completion of questionnaire was optional for the resident physicians, consent was implied when residents participated in the program and completed the questionnaire. This study was approved by Institutional Review Board at Beaumont Health .
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Breast Cancer And Your Risk
For readers interested in the PDF version, the document is available for downloading or viewing:
This brochure identifies biological as well as lifestyle factors associated with breast cancer. It offers information and advice to help you better understand and address them. It also identifies common misconceptions about breast cancer and includes helpful tips and useful website addresses to help you stay informed.
It is intended for women who:
- are 18 years of age or over and
- do not have breast cancer or any breast problems. You should report any changes in your breasts or concern you might have about your breasts to your doctor.
Patient Is At Higher Risk For Eobc
- Recommend an annual or semiannual mammogram and MRI. If the patient is under 30, start with an ultrasound. For patients with a history of thoracic radiation, start mammograms and MRIs 10 years after radiation.
- Refer to a genetic counselor for follow-up. Patients with known genetic risk factors may benefit from referral to a genetic counselor for additional follow-up.
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Encourage All Patients To Reduce Their Risk
- Limit alcohol to one drink per day.
- Breastfeed if they have a baby.
- Eat healthy.
- Engage in moderate exercise for 30 minutes per day, at least five days per week.
- Get 7 or more hours of sleep per night.
- Know what their breasts look and feel like and report any changes such as lumps, thickening or swelling, irritation, dimpling, redness, flakiness, nipple inversion, pain, or discharge to a health care provider.
- Learn their family history of breast and ovarian cancer and share it with their health care provider.
- For average-risk women, get a mammogram every two years from age 50 through 74. Screening can find problems early.