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“I didn’t think it could be cancer, because no one in my family has had breast cancer.”

This is one of the most common things a breast cancer specialist hears, and it reflects at once an understanding that family history affects the risk of developing breast cancer, but also a misunderstanding of the fact that all women are at risk.

During the past 15 years there has been an exponential growth of our understanding of how to predict a individual’s risk of developing breast cancer. This includes the well-known clinical risk factors such as family history, the age of onset of menses, the age of first full term pregnancy, and has evolved to include more detailed familial and genetic risk factors and analysis of tissue from previous breast biopsies. Today, there are actually books written on the topic determining breast cancer risk – a very important topic, since there are now accepted techniques to actually reduce your risk.

Complete risk assessment includes an analysis of several factors:
  • Epidemiologic risk factors such as age, race, family history, age of onset of menses and first pregnancy, and number of breast biopsies.

  • Familial risk factors including the number of relatives with breast cancer and their relationship to you.

  • Genetic risk assessment, primarily risk of a mutation in the breast and ovarian cancer genes (BRCA 1 and 2), but also some new expanded genetic panels.

  • Histologic risk, or the risk of future breast cancer based on the findings on prior breast biopsies or other breast surgery.

As we have all seen on the internet or heard on the radio, genetic testing panel offered by "23andMe" or "MyAncestry.com" have become relatively inexpensive ($150-250) and can be ordered online without a doctor's prescription. Similar expanded panels to test for cancer predisposition are also available. In particular, a company called "Getcolor.com" will test for up to 30 cancer risk genes for $249. Soon, we can all anticipate even larger panels, and the problem will become intepreting the information.

Feel free to discuss this during your visit, understanding that often it's a family member with cancer who will benefit the most from testing.