Category : Potentially High Risk
Less than 1% of women are in this group.
Women in this group have a family history of breast cancer or ovarian cancer occurring in:
- Two first- or second-degree relatives on the same side of the family, plus
One or more of the following features:
- Additional relatives with breast cancer or ovarian cancer
- A relative with both breast and ovarian cancer
- Breast cancer diagnosed before the age of 40
- Breast cancer affecting both breasts
- Ashkenazi Jewish ancestry
- Breast cancer in a male relative
- A relative who has tested positive for a high-risk gene mutation e.g. a mutation in genes such as
The risk of developing breast cancer in this group is potentially higher than that of the general population.
Some People Have A Significant Family History Of Breast Cancer
Sometimes, someones family history suggests they could be at increased risk of developing breast cancer.
This is known as having a significant family history.
This may be because theres an altered gene in their family that increases the risk of breast cancer.
Only about 510% of breast cancers are due to having inherited an altered gene.
Someone may be more likely to have a significant family history if two or more close relatives were diagnosed with breast cancer at a younger age, or if one relative has had breast cancer in both breasts.
Choosing Surgery To Prevent Breast Cancer
Ninan says women with BRCA1 or BRCA2 mutations face a significant risk of breast and ovarian cancer. Prophylactic removal of the fallopian tubes and ovaries is recommended by about age 40. Many women with BRCA1 or BRCA2 mutations will also elect to have their breasts removed. Nipple-sparing mastectomy is an effective option for these patients, she says.
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.
If you are facing this decision, you are not alone. Caring specialists can ensure you have all the facts, and, if surgery is ultimately your choice, 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 , your doctor can refer you to a specialist in gynecological oncology.
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Waiting For An Assessment
Being referred to a family history clinic for assessment can be a worrying time.
Its natural to feel anxious when youre waiting for a risk assessment.
Youll probably have your own way of managing your anxiety during this time of uncertainty, such as keeping busy or talking to family and friends.
If you would like to talk to someone about any concerns, you can call our free Helpline on 0808 800 6000.
What Is A Family Cancer Clinic
If you feel you may be at high risk of developing breast cancer, you can talk to your doctor about referral to a family cancer clinic. There you will see a genetic counsellor, family cancer nurse, or specialist doctor trained in genetics. They will take a detailed family history to define your risk and discuss your options with you. They may arrange genetic testing and may discuss ways to reduce your risk of breast cancer.
Family cancer clinics also investigate family history of other cancers such as bowel cancer.
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Breast Cancer Screening For Women With A Strong Family History Of Breast Or Ovarian Cancer
There are special breast cancer screening guidelines for women with a strong family history of breast or ovarian cancer.
If you have a greater than 20 percent lifetime risk of breast cancer based mainly on your family history of breast or ovarian cancer, the National Comprehensive Cancer Network recommends you get a :
- Clinical breast exam every 6-12 months, but not before age 21
- Mammogram every year, starting at age 40 or starting 10 years younger than the youngest breast cancer case in your family
- Breast MRI every year, starting at age 40 or starting 10 years younger than the youngest breast cancer case in your family
Learn more about breast cancer screening recommendations for women at higher risk.
Comprehensive Effects Of All Three Aspects Of Family History
To further analyze the contribution of degree, cancer type, and number of relatives on the breast cancer features of the patients, multiple logistic regression was performed using these three factors . We found that compared with patients with a single relative with breast/ovarian cancer, patients with multiple relatives with breast/ovarian cancer had a significantly increased risk of being diagnosed with cancer of a high histologic grade . Moreover, compared with the F-FH group, more patients in the S/T-FH group were aged less than 35 years . These three factors did not independently affect other parameters in terms of hormone receptor, HER2, and Ki67 status.
Table 7 Multiple logistic regression test on degree, type, and number of relatives with family history of cancer, and patients tumor characteristics.
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Who Is At Risk For Inherited Breast Cancer
Your risk may be increased if your relative developed breast cancer at a young age or if the relative is very closely related, like a mother, sister or daughter, Ninan says. Having a family history of early onset breast cancer in close relatives may be a reason to look into genetic testing.
A comprehensive breast center has experienced breast specialists who can help clarify what course of action might be best for you, she says.
If I Have A Family History Of Breast Cancer When And How Often Should I Be Screened
BreastScreen NSW recommends a regular mammogram every 2 years for all women aged 50 74 years. For some women, the nature of their family history may require them to have a mammogram more frequently.
From the age of 40, it is recommended that women have a mammogram annually if:
- they have a first-degree relative who has been diagnosed with breast cancer before the age of 50
- they are assessed by BreastScreen NSW and/ or their doctor as being High Risk , using the Familial Risk Assessment Breast and Ovarian Cancer tool, developed by Cancer Australia.
If you fall into either of these categories, you may need additional monitoring and tests that BreastScreen NSW is unable to provide. You may wish to talk to your doctor about a referral to a familial cancer clinic for further assessment.
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Breast Cancer Risk And Breast Awareness
You may feel reassured to know that only a small number of breast cancers are due to having a significant family history.
However, breast cancer is still the most common cancer in women in the UK.
One in seven women in the UK will develop breast cancer in their lifetime.
Its important to be breast aware. This means:
- Checking your breasts regularly, so you know what looks and feels normal for you
- Contacting your GP if you notice a breast change thats new or unusual
Im Worried About My Family History Of Breast Cancer What Can I Do
If you are concerned about your risk of breast cancer and family history, you can visit your GP. They will be able to look at the patterns of cancers in your family to see whether you might be at an increased risk of breast cancer. If they think you might be, they will refer you to specialist services. Find out more about how genes affect our risk of developing breast cancer.
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Who Should Be Referred For Assessment
You should be referred for an assessment of your risk if:
- One first degree relative has had breast cancer before the age of 40
- One first degree male relative has had breast cancer at any age
- One first degree relative has had breast cancer in both breasts at any age
- One first degree or second degree relative has had breast cancer at any age and one first degree or second degree relative has had ovarian cancer at any age
- Three or more first degree or second degree relatives have had breast cancer at any age
First degree relatives include your mother, father, brothers, sisters and your children.
Second degree relatives include aunts, uncles, grandparents, nieces and nephews.
You may also be referred if:
- You have Jewish ancestry
- You or a relative has had sarcoma before the age of 45
- You or a relative has had glioma or childhood adrenal cortical cancer
- Your family has had a number of cancers at a young age
- Two or more relatives on your father’s side of the family have had breast cancer
Family History And Risk Assessment
The proportion of women in the population with a family history of breast cancer in a first-degree relative has been estimated to be approximately 8.4%. Further, the likelihood of having a family history of breast cancer in a first-degree relative increases with increasing age. Thus, among women aged 20 to 29 years, only 2.7% report a family history of breast cancer, while 11.6% of women aged 50 to 59 years report a family history of at least one first-degree relative with breast cancer. Of those who cite a family history of breast cancer in first-degree relatives, less than 10% have more than one relative affected, with only 1% having three or more first-degree relatives with breast cancer.164 In series of breast cancer patients, a family history of breast cancer in a first-degree relative is more common, approaching 14%.165,166 Even among breast cancer cases, however, having more than one family member affected is not common. In one large study, less than 2% of breast cancer cases reported having more than one first-degree relative affected by breast cancer.165
Individuals from high-risk families should be referred to multidisciplinary centers providing genetic counseling and access to genetic testing. Risk management strategies range from earlier and more intensive surveillance to chemoprevention and risk-reducing surgeries .
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Age Of Family Member At Breast Cancer Diagnosis
In general, the younger the relative was when she was diagnosed, the greater a womans chance of getting breast cancer .
For example, a woman whose mother was diagnosed with breast cancer before age 40 has about twice the risk of a woman without this family history . For a woman whose mother was diagnosed at an older age, the increase in risk isnt as high.
Family Health History And Cancer
Genetic testing may have a ripple effect to other family members for multiple generations, oncologist Dr. Alter explains in this video about collecting cancer patients family health history. You can actually save a life.
Learn your familys health history and share it with your doctor.
Your family health history is a record of diseases and conditions that run in your family. Your family members may share genes, habits, and environments that can affect your risk of getting cancer.
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Taking Charge: Who Gets Breast Cancer
There are no rules about who gets this disease. The two most significant risk factors are being a woman, and increasing age. However, there are other factors that may increase your risk, and some that may lower it.
The development of breast cancer may be influenced by factors that affect the levels of female hormones that circulate in your body throughout life. These factors include the age when you began your menstrual period, the number of times you have been pregnant, your age at first pregnancy, whether you have breastfed your children, and your level of physical activity.
Category : At Or Slightly Above Average Risk
95% of women are in this group.
Women in this group have:
- No family history of breast cancer, or
- Family history of breast cancer occurring in:
- One first-degree relative at age 50 or older, or
- One second-degree relative at any age, or
- Two first or second-degree relatives over the age of 50, on different sides of the family, or
- Two second-degree relatives on the same side of the family, both with breast cancer at age 50 or older
The risk of developing breast cancer in this group is the same or only slightly higher than the average woman in the general population.
90% of women in this group will not develop breast cancer.
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Who Should Be Tested For Genetic Breast Cancer Risk
Ninans recommendation to anyone who suspects he or she might be carrying a gene that increases cancer risk: Start with genetic counseling.
Deciding to undergo the testing is a big decision, and not an easy choice to make. It is important to consider the potential impact of test results on your well-being, your career, your family and other aspects of your life, she explains.
Knowing the results could affect your health and affect other family members, including your siblings and children. For instance, someone with a genetic mutation has about a 50% chance of passing that trait to his or her children.
Ninan says the guidelines for who should be tested change over time, but in general, your doctor might want to discuss gene testing with you if:
- Someone in your family has tested positive for carrying a mutated gene.
- You are of Ashkenazi Jewish ancestry.
- You were diagnosed with breast cancer before age 50.
- A man in your family has been diagnosed with breast cancer.
- You were diagnosed with ovarian cancer.
- There are multiple breast cancers on one side of your family.
- You or a relative has had cancer diagnosed in both breasts.
Family History Risk Assessment
If youre concerned about your family history of breast cancer, you may be eligible for a family history risk assessment.
This assessment will be able to tell you, based on your family history, what your risk of developing breast cancer may be.
The risk assessment is carried out at a specialist family history clinic or a regional genetics centre, depending on where you live.
You will usually need to be referred by your GP.
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The Nci Bcddp Follow Up Study
The Breast Cancer Detection Demonstration Project , sponsored by the American Cancer Society and the National Cancer Institute , was a breast cancer screening programme conducted between 1973 and 1980. The BCDDP provided up to five annual breast examinations to 283 222 women at 29 screening centres in 27 cities throughout the United States. Over 99% of the participants were between the ages of 35 and 74 when they entered the screening programme, with a median age of 50 years. The NCI began a follow up study of a subset of the BCDDP participants in 1979, which included all women who were diagnosed with breast cancer during the BCDDP all women who had breast surgery performed during the screening programme with no evidence of malignant breast disease all women who had received a recommendation by the project for a surgical consultation, but who did not have either a biopsy or aspiration performed and a sample of women who were not recommended for surgical consultation and did not undergo a biopsy .
Effect Of Cancer Type In Family History On Breast Cancer Features Of Patients
Among the 776 patients, 617 had a family history of only breast/ovarian cancer , and 159 patients had a family history of multiple types of cancers , including breast/ovarian and other types of cancers. Although no significant difference was found in clinical stages and molecular subtypes between single-FH and multiple-FH groups, a 1.5-fold increase in the percentage of patients classified as histologic grade III was observed in the single-FH group . A similar finding was noted when the single-FH and non-FH groups were compared. Compared with the non-FH group, the single-FH group had a higher percentage of patients with stage N0 , lower percentage of patients with stage TNM-III , but higher percentage of patients with higher-histological-grade tumors and those with the most aggressive subtype of breast cancer, namely TNBC .
Table 5 Types of cancer in relatives and patients tumor characteristics.
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Female Family Members With A History Of Breast Cancer
Most women diagnosed with breast cancer dont have a family history of the disease.
About 15 percent of women diagnosed with breast cancer have a first-degree female relative whos also had it .
A woman who has a first-degree female relative with breast cancer has about twice the risk of a woman without this family history . If she has more than one first-degree female relative with a history of breast cancer, her risk is about 2-4 times higher .
What Are The Risks Of Hrt For All Women
For the vast majority of women, the benefits from taking HRT outweigh any risks. The risks of HRT depend on the type you are given and also other factors such as your age and general health. Because there are different factors at play in determining an individuals risk of breast cancer, its so important to have a personalised consultation with your doctor to discuss your actual risks.
Many women worry about breast cancer when taking HRT, but most types of HRT do not actually increase the risk of breast cancer. Some studies have shown that women taking combined HRT containing both estrogen and a progestogen may be associated with The increased risk is related to the type of progestogen in the HRT and not the estrogen.
Taking micronised progesterone has not been shown to be associated with an increased risk of breast cancer. Even for women taking the synthetic progestogen, the risk is very low and is actually less than the increased risk of breast cancer associated with drinking a couple of glasses of wine each night, or from being overweight.
No studies have shown that any type of HRT increases the risk of a womans death from breast cancer. If you have had a hysterectomy in the past, and are just taking estrogen without a progestogen, you actually have a lower risk of breast cancer than if you did not take HRT at all.
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