Barbara Fallon, M.D., oncologist [November 07 2013]
When Angelina Jolie publicized her decision to have prophylactic bilateral mastectomies to reduce her risk of getting breast cancer it raised many questions for women (and men) and with that, much anxiety. Most women overestimate their personal risk of getting breast cancer, and even worse, of dying from breast cancer.
Breast cancer is a common disease. In terms of frequency the most important risk factor for getting breast cancer seems to be age. Most cases (two-thirds) occur in post-menopausal women and most patients do not have a family history. That said, there are some factors that increase the chance of getting breast cancer, and some of these may warrant action on the part of a woman who's concerned. For example, a woman who has a mother, daughter or sister diagnosed with breast cancer has an increased risk of getting breast cancer. Moreover, if a relative was young at diagnosis or had bilateral breast cancer, or if a relative has had ovarian cancer or a male relative has had breast cancer, that is suggestive of an identifiable genetic predisposition toward breast cancer, i.e. BRCA 1 or BRCA 2 genetic mutation syndromes. Certain ethnic groups such as Ashkenazi Jews have a higher risk of carrying the BRCA genes. Other cancers in the family may also increase the risk of breast cancer, but these are even less common than the BRCA syndromes.
A woman's personal health history may also convey an increased risk. For example, early age at beginning menstruation, no pregnancies or the first pregnancy at a later age, prior history of breast cancer or a prior breast biopsy that shows atypical cells, use of some types of hormone replacement therapy after menopause can all increase a woman's risk. Lifestyle factors like diet, body weight and alcohol use also seem to play a role; but how much and when they influence risk is still being studied. Finally, we all worry about chemicals in our environment but exactly which ones and what kind of exposures contribute to breast cancer are yet to be determined.
If you or a friend or family member is concerned about breast cancer risk it's best to get the facts about your personal risk. For example, a woman can call The Hospital of Central Connecticut at 860-827-0525 ext. 4 for an appointment with a breast cancer nurse navigator to estimate her risk. Most of the time it will be lower than the woman expected.
Sometimes an increased risk or even a high risk of getting breast cancer will be found and the woman will be given information about ways to reduce her risk and if appropriate, referrals for genetic counseling or to a health professional who can discuss medical options and screening strategies. For the rare patient, prophylactic surgery may be the right choice.
Dr. Barbara Fallon is medical director of the breast program at The Hospital of Central Connecticut (HOCC). For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org.