Breast Cancer: Know Your Risks

Did you know that women living in the United States have a 1 in 8 or 12% chance of developing breast cancer in their lifetime? Breast cancer is one of the most common cancers among women, second to skin cancer. According to the American Cancer Society, in 2022 an estimated 287,850 women and 2,710 men will be diagnosed with breast cancer. In addition, since the mid-2000s the incidence has increased by 0.5% per year. For these reasons and more, screening mammograms remains a key strategy for early detection as early diagnosis increases more treatment options and improved survival rates. Women are encouraged to begin screening mammograms beginning at age 40 or sooner for: personal/family history of breast cancer or if considered at high risk for breast cancer.

Having a risk factor or several does not necessarily mean that someone will develop breast cancer. Most women who have one or more breast cancer risks will never develop the disease while many women with breast cancer will have no apparent risk factors other than being born female and growing older. It’s not always predictable how much or how many of the risk factors contribute to the diagnosis.

Some risk factors are modifiable meaning they can be changed or improved. For example personal behaviors such as smoking, alcohol consumption, in active lifestyle, being overweight or obesity after menopause. Non modifiable risk factors are those that cannot be changed such as age, being born female, race, reproductive history or inherited genetic mutations.

Knowing more as it relates to inherited genetic mutations is optimal for women diagnosed with breast cancer and who have high risk features.

Genetics

Although most breast cancers occur sporadically, about 5% - 10% of cases are hereditary and caused by germline mutations. Germline mutations are gene changes in a body's reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of the offspring, therefore are hereditary. Specialized testing using saliva or blood samples can look for germline mutations in genes. Positive results of these tests would impact cancer screenings and treatment recommendations. For example, women who test positive for BRCA mutation without a breast cancer diagnosis may be recommended to start clinical breast exams and annual screenings with MRI starting at age 25.

Women with germline mutations in BRCA1 and BRCA2 genes, can have a 60-85% risk of developing breast cancer which is a significant increase compared to the general population. In brief, the BRCA 1 and BRCA 2 genes normally protect against certain cancers, however changes or mutations in these specific genes inhibit normal function of cells in the body which may eventually form a tumor.

Genetic testing for the BRCA gene is not currently recommended for the general population. In fact, the focus is on those who have a higher likelihood of carrying the germline mutation. Who should consider genetic testing? Guidelines from expert groups identified criteria for genetic counseling or testing based on personal and family history such as: early onset of breast cancer diagnosed before age 50, triple negative breast cancer, ovarian cancer, pancreatic cancer, high risk prostate cancer, uncommon cancers such as male breast cancer or diffused gastric cancer, and individuals of Ashkenazi Jewish ancestry.

Beyond BRCA1/2 genes, more than 20 genes have been identified to increase breast cancer risk. For anyone wanting to know more about their breast cancer risk should have a comprehensive discussion with their health care provider or genetic counselor.

The Robert & Beverly Lewis Family Cancer Care Center, offers genetic counseling services and are available for our patients with a cancer diagnosis and/or clients with family history of cancer. The genetic counselor works directly with the oncology team to plan and discuss individualized testing for patients. The genetic counseling services will include but not limited to:

• Identifying individuals at risk for hereditary cancer through detailed family history intake and assessment.
• Providing education and counseling about specific genetic syndromes if relevant
• Facilitating decision-making process on genetic testing options of cancer genes or other conditions when indicated by the National Comprehensive Cancer Network guidelines or per patient request.
• Order genetic testing via third party genetic testing laboratories.
• Helping individuals derive meaning from their testing result and counseling, as well as empowering them to make educated, informed decisions about
  • Cancer screening
  • Cancer prevention, including medical and/or surgical prophylaxis.
• Offer resources for patients who are interested in patient assistance programs, advocacy/support groups, and research opportunities related to genetic status or cancer prevention/management.

Take charge of your breast health by:

• Knowing your personal and family health history
• Stay up to date with screening mammograms
• Know what is normal for you/identify breast changes
• Make healthy lifestyle choices

For more information about genetic counseling services, please contact:

Cancer Genetics Program
The Robert & Beverly Lewis Family Cancer Care Center
1910 Royalty Drive, Pomona, CA 91767
Phone: 909.865.9965