For Your Family Members

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 Screening • Genetic Testing

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Screening
Although the majority of cases of breast cancer are not hereditary, having a first degree relative, either on the mother's or father's side, does increase the likelihood of developing breast cancer. A good word of advice is to inform your family members of your diagnosis, and suggest that your daughters or sisters be particularly thorough in practicing early detection.

The current recommendations include yearly mammograms starting either at age forty, or at an age that is ten years younger than yours at the time of your diagnosis, whichever is earlier.

For younger women, whose breasts are more dense, and more difficult to be examined by mammography, there are techniques available such as ultrasound and MRI that will help spot smaller changes.

Mammography itself is constantly undergoing refinement. For example, new digital systems make image management easier. There are also computerized programs that enhance the physicians' ability to interpret images rapidly and effectively. And for those women who avoid mammograms for fear of the discomfort caused by the compression, new user-friendly foam pads make much of the discomfort obsolete.

In addition, BSE is important for younger women, who are not yet at the mammogram screening age of over 40. For these women, the only tools readily available are clinical breast examinations and monthly self-examination.

A newly released guideline recommends annual MRI in addition to mammography for women who are at high risk of developing breast cancer— which may include your first degree relatives.

 

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Genetic Testing
One of the questions that women who have been diagnosed with breast cancer ask is, "Should my close relatives be tested for breast cancer genes?" This is not a simple question.

The tests that are available today look for abnormalities in the BRCA genes. If abnormalities are found, then the person has a higher risk of developing breast cancer.

The issue is, what will that person do with the information? At present, the options include prophylactic mastectomy—removal of both breasts as a pre-emptive measure, or hormone treatment (such as with tamoxifen) that will induce menopause. Neither is an attractive choice. In addition, if the test is negative, it does not mean that the person will not develop breast cancer. If the test is positive, there may be a risk that a health insurance company, or a potential employer will somehow access the information, and use it in a prejudicial way.

The complicated decision of whether to undergo genetic testing should be made with the help of a genetic counselor trained in risk assessment, and the woman must be very clear about the expected benefits and risks.

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