Understanding your breast cancer risk

Dr. Abhishek Chatterjee. (Image courtesy of Tufts Medical Center.)

By Dr. Abhishek Chatterjee, Tufts Medical Center

 

  1. What are some major risk factors for breast cancer?

There are many risk factors for breast cancer. Major risk factors include a personal history of having breast cancer, previous high-risk breast lesions that include atypical cells, and ductal carcinoma in situ (DCIS), first-degree relatives who have had breast cancer, especially at an age less than 50, or a personal history of having chest wall radiation at an age younger than 40. Additionally, having a hereditary genetic mutation such as BRCA 1 or BRCA 2 puts a woman at high risk for developing breast cancer in either breast, according to 2015 research from the American Cancer Society.

 

  1. What should a woman do if she has one or more of these risk factors?

It is important for woman with one or more risk factors to have a discussion with her primary care doctor. The doctor in turn will decide whether or not this woman should see a high-risk breast cancer specialist, who is often either a surgical or medical oncologist specializing in breast disease. Additionally, this woman may need early breast screening using technology such as mammography, ultrasound, magnetic resonance imaging (MRI), or a combination of these.

 

  1. What are hereditary genetic mutations for breast cancer? When does a woman qualify for genetic testing?

Approximately 10 percent of all breast cancers are caused by genetic mutations that can be inherited from family members. Breast cancer tends to be common in the family tree and may even occur in males.

Certain genes are essential in preventing breast cancer. When there are mutations causing faulty functioning genes, breast cancer tends to develop, and these mutations can get passed on from one generation to the next.

Fortunately, modern medical science continues to assess what mutations cause breast cancer and how much risk these mutations place on a patient. To qualify for genetic testing, breast cancer centers, such as the one at Tufts Medical Center, have genetics counselors who assess risk factors for the patient and get a detailed family history. Some qualifying factors for genetic testing include a woman less than 40 years of age with newly diagnosed breast cancer, having several first-degree family members with breast cancer or ovarian cancer, or being a male with breast cancer.

 

  1. What are examples of hereditary genetic mutations in breast cancer?

The two most common and well-studied hereditary genetic mutations in breast are the BRCA 1 and BRCA 2 mutations. These increase the lifetime risk of getting breast cancer by 40 to 80 percent and increase the risk of getting ovarian cancer by 30 to 70 percent. To place this in perspective, a woman with no breast cancer risk factors has a lifetime breast cancer risk of 13 percent.

There are many other types of hereditary genetic mutations, but a substantial number of these have unknown risk or significance. More is found out about hereditary mutations everyday through breast cancer research.

 

  1. What should a woman do if she is BRCA 1 or BRCA 2 positive?

A woman with these genetic mutations should be followed by a breast genetics specialist and counseled about her options. Given her ovarian cancer risks, she should also discuss her options regarding having her ovaries removed at a particular time with a gynecologist who specializes in treating patients with such mutations.

With regards to breast treatment, many women choose to undergo the removal of both breasts and this decreases their risks of future breast cancer to 5 percent. Women who do this, after counseling with a genetics specialist and breast surgical oncologist, have the option for breast reconstruction that could include implant-based or flap-based reconstruction. Having your breasts removed is a very difficult decision and some women choose to keep their breasts. If this is done, then women with the BRCA 1 or BRCA 2 mutation need to be followed very closely with annual mammograms and most likely annual MRI breast screening.

There is no correct answer in what a woman should do. Rather, a personal, informed decision by the patient after discussion with the appropriate doctors should be made.

 

About the author

Dr. Abhishek Chatterjee is a breast surgical oncologist and a plastic and reconstructive surgeon at Tufts Medical Center. He finished his breast surgical oncology fellowship at the University of Pennsylvania after completing a plastic surgery residency at Dartmouth Hitchcock Medical Center. His surgical specialty interests include the treatment of breast cancer.

 

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