Familial Breast Cancer
Familial breast cancer accounts for 5% of all diagnosed breast cancer. Management of patients with a family history of breast cancer can be challenging. The main focus is to determine a patients’ risk of developing breast cancer based on their family history and then provide options to manage this risk.
Patients with a breast cancer or those who have family history of breast cancer may wish to consider genetic testing. Patients who are deemed to have a high chance of carrying a genetic mutation relating to breast cancer are eligible for a Medicare-funded genetic test. Patients who have a lower chance of carrying a genetic mutation relating to breast cancer may elect to self-fund genetic testing which typically costs approximately $400. Genetic testing is performed in conjunction with genetic counselling.
Non-Genetic High Risk Patients
Most patients will not have a genetic mutation placing them into a high risk category for breast cancer. Patients can however have a high risk of developing breast cancer without a genetic mutation being present. Breast cancer risk can be influenced by a number of factors including:
- Increased age
- Family history
- High breast density
- Previous atypical breast lesions
- Absence of breast feeding
- Use of hormonal therapies
- Obesity
- Absence of pregnancy or advanced age at first pregnancy
- Radiation exposure
- Lifestyle factors such as high alcohol intake and physical inactivity
A high risk for breast cancer is defined as a 10 year risk over 5% or a lifetime risk over 25%. There are risk calculators which assign a breast cancer risk to a particular patient.
The most commonly used calculators are (links attached):
Management of High Risk Patients
Patients who test positive for a genetic mutation relating to breast cancer or who are considered high risk for breast cancer are best managed in a high risk screening pathway. High risk patients should be offered risk-reducing measures such as risk-reducing surgery and risk-reducing medication. Dr Gannan commonly manages high risk patients and encourages patients to have their breast cancer risk assessed and managed accordingly. Management plans are tailored to the patients’ risk profile and personal preferences.