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A local expert talks about determining risk percentages based on genetics.
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We’ve all heard that breast cancer runs in families but what precisely does that mean? To learn more, we talked with Faith Callif-Daley, genetic counselor at Dayton Children’s and Samaritan Cancer Center.
“Family history is a well known risk factor for breast cancer,” she explains. “At least 20 percent of women diagnosed with breast cancer have some family history of the disease. When a woman has a family history of breast or related cancers her own risk for breast cancer may be increased.”
Q. Exactly which relatives are we talking about when it comes to family history? Does it matter, for example, if my grandmother on my father’s side had breast cancer? Or an aunt? Or a cousin?
A. Your doctors may modify your plan for cancer prevention or early detection based on your family history. Collect the details of cancer diagnoses for at least three generations on both sides of the family. This includes you, your parents, children, siblings, nieces, nephews and grandchildren as well as your aunts, uncles and first cousins on both sides of the family.
Paternal family history is just as important as maternal history. Someone with an affected paternal grandmother and paternal aunt may have as much risk for breast cancer as someone with an affected mother and maternal aunt. Risk generally increases with more affected relatives, younger age of onset of disease and/or closer relationship.
“My Family Health Portrait” is an online tool created by The U.S. Surgeon General’s Office (www.hhs.gov/familyhistory) to create your own medical family tree. Update your family history often and share it with your doctors. Thanksgiving Day has been designated National Family History Day to remind us to talk to our relatives regularly about our medical family history.
Q. What about other forms of cancer in our family, can that affect my chances of getting breast cancer?
A. A family history of ovarian cancer is strongly linked with increased breast and ovarian cancer risk. Cancers of the thyroid, stomach, uterus, pancreas, bone, prostate, colon, skin and adrenal gland may also be important.
Q. If my mother had breast cancer, what does that mean for me? Does it mean I will definitely get breast cancer someday?
A. When a woman is diagnosed with breast cancer, her thoughts always turn to her daughter. Is breast cancer her destiny? Not necessarily. She may need to be followed more closely as a precaution, but breast cancer need not be her fate. There are many elements to estimating breast cancer risk.
Q. We now know there are many kinds of breast cancer. Does the type a family member had affect what kind I would get?
A. For some hereditary forms of breast cancer, one type of breast cancer may be more common than another, but in most cases a close relative’s form of breast cancer is not predictive.
Q. Does it matter if my mother had breast cancer after menopause or before?
A. Premenopausal breast cancer is more likely to be inherited.
Q. I’ve heard about the BRCA 1 and 2 tests. What are they? What’s the difference between the two? Who should have the test?
A. BRCA1 and BRCA2 are the most common genes associated with hereditary breast cancer. They are very similar and are usually tested together. People with BRCA1 or BRCA2 mutations have significant increased lifetime risks for breast cancer (85 percent for both) and ovarian cancer (50 percent for BRCA1 and 30 percent for BRCA2).
To see who the National Comprehensive Cancer Network considers candidates for BRCA1/BRCA2 testing, see www.nccn.org.
Q. I’ve heard that sometimes insurance won’t pay for that test and that it is quite expensive. What should I do if I want to have it and it won’t be covered?
A. Insurance companies, including Medicaid and Medicare, are actually quite good at covering the testing when it is medically necessary. In most cases, when insurance does not cover the testing it is because there is a low likelihood for a mutation and it is reasonable not to test. In other cases, the testing laboratory, Myriad Genetics, can set up a reasonable payment plan. Patients without insurance who meet specified financial and medical criteria can have testing free of charge through the lab’s Financial Assistance Program.
Q. What kinds of studies are being done in this field and what might we learn from them?
A. The most recent studies emphasize personalized care. For instance, clinical trials are studying whether PARP inhibitors may be more effective than standard chemotherapies at treating cancers in patients with BRCA1 or BRCA2 mutations. Also, additional genetic risk factors, beyond BRCA1 or BRCA2, are continually being identified and studied.
Q. How would the recommendations for prevention be different for a woman who has breast cancer in her family?
A. The specific recommendations would vary with the risk level. For those with a lifetime risk for breast cancer greater than or equal to 20 percent, annual breast MRI is an important part of breast cancer screening. Some patients are candidates for risk reducing medicines or procedures including: Tamoxifen, preventive removal of the ovaries and/or preventive mastectomy.
Contact this reporter at (937) 225-2440 or MMoss@DaytonDaily News.com.
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