Women's Health Medicine
Volume 3, Issue 1 , Pages 28-30, January 2006

Management of a woman with a family history of breast cancer

  • EL Lynch, Grad Dip Genetic Counselling

      Affiliations

    • E L Lynch Grad Dip Genetic Counselling is a Genetic Counsellor at the Royal Marsden NHS Trust, London, UK. She qualified at the University of Melbourne, Australia, and her interest is in the area of cancer genetics.
    • ,
  • RA Eeles, PhD FRCP FRCR

      Affiliations

    • R A Eeles PhD FRCP FRCR is a Reader and Honorary Consultant in Translational Cancer Genetics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK. As a clinician and scientist, the main theme of her work is to bring research findings into the clinic, with particular reference to prostate and breast cancer.

Article Outline

Abstract 

Recent media publicity about breast cancer has caused concern for many women. Most women with a relative with breast cancer are not at substantially increased risk. NICE released revised guidelines in 2004 classifying women into risk groups. When a woman presents with concerns, it is important to take a full family history. For those that fit into a high-risk group, referral to tertiary care may be appropriate. Genetic testing of BRCA1 and BRCA2 may be offered in families where there is a living affected family member to test first and can be offered to unaffected individuals when there is Ashkenazi Jewish background. Breast management options for those at high risk include breast screening from a young age. MRI screening also appears to be useful. The efficacy of ovarian screening is being studied although it is known that prophylactic oophrectomy before menopause reduces the risk of both breast and ovarian cancer. Prophylactic mastectomy is also an option for these women. Genetic counselling and psychosocial support are important.

Keywords:  breast disorders , BRCA1 , BRCA2 , breast cancer , genetic counselling , genetic testing , family history , management , ovarian cancer , screening

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REFERENCES 

  1. Lakhani SR , et al.   The pathology of familial breast cancer: predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2 and p53 in patients with mutations in BRCA1 and BRCA2 . J Clin Oncol . 2002;20:2310–2318
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  9. Rebbeck. et al. Prophylactic oophrectomy in carriers of BRCA1 or BRCA2 mutations. N Eng J Med 346: 1616–22
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FURTHER READING 

  1. Ardern-Jones A , Eeles R . Cancer genes – management of carriers of breast cancer genes who have already developed cancer: the Carrier Clinic Model . European Journal of Cancer Care . 2002;11:63–68 (An outline of the unique carrier clinic model set up at the Royal Marsden NHS Foundation Trust.)
  2. Eeles  , et al.   Genetic predisposition to cancer . 2nd edn.. London: Arnold; 2004; (A guide for those in clinical practice and research outlining all aspects of familial cancer.)
  3. Narod S , Foulkes W . BRCA1 and BRCA2:1994 and beyond . Nature Reviews Cancer . 2004;4:665–676 (A good up-to-date, recent summary article for clinicians.)

PII: S1744-1870(06)00121-1

doi:10.1383/wohm.2006.3.1.28

Women's Health Medicine
Volume 3, Issue 1 , Pages 28-30, January 2006

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