Question regarding family history

morningperson

Hello, I am 49, birads 3, with 8mm solid, oval mass in the right breast. Currently, I am waiting 3 months for another ultrasound, and was reviewing my family history. My paternal grandmother had breast cancer; she had two sons, no daughters. My sister is 55, so we are both really past the age where the BCRA genes matter since these genes are associated with breast cancer in younger women, but I am curious whether or not my risk has been understated since my grandmother did not have any daughters. I currently do not know how old she was when she had cancer, but I am trying to find out.

Thanks in advance for any help!

Beesie

BRCA genetic mutations, and the other more rare genetic mutations that increase breast cancer risk, also increase the risk for other cancers.  So males could be affected as well. 

The most obvious sign would be male breast cancer.  But other than that, did your father or your uncle have prostate cancer?  Other cancers that could indicate the presence of a genetic mutation would be pancreatic, thyroid, colon and stomach cancers, and possibly melanoma.  What about cousins and siblings?  Have any of them had any of those cancers, particularly at a younger age?

Most breast cancer is random, not genetic.  So unless there is a pattern of these types of related cancers within the family, it's more likely that there is no genetic link.

Hereditary Breast Ovarian Cancer Syndrome (BRCA1 / BRCA2) 

Genetics:  http://www.breastcancer.org/risk/factors/genetics 

leaf

I had a paternal grandmother who only had 4 sons, no daughters, and she had breast cancer with bilateral mastectomies.  I ended up getting referred to a board certified genetics counselor.  It took a lot of work to get the information from one of her sons, but it ended up my paternal grandmother's cancer was when she was over 50. This was in the early 1950s, so this was probably before the age of chemotherapy (hence the bilateral mastectomies).  A maternal aunt also had postmenopausal breast cancer. I am not Ashkenazi Jewish, nor is there any male breast cancer history in my family.  I had a sister who never had breast cancer. I was told that my chance of having a BRCA mutation was low, about 2% of the people like me.  My family has more than the usual amount of cancer, but probably not BRCA.  

On my genetics family tree information, they didn't ask for any information about cousins; only grandparents, parents, uncles and aunts, sibs, children, neices and nephews.  This was in 2006, so perhaps things may be different now and other places might do it differently, but I'd be surprised.    (I had my genetics consult at an NCI-certified center by a  board-certified genetics counselor.  That's what places like FORCE recommend:  http://www.facingourrisk.org/info_research/finding-health-care/finding-specialists/index.php?hgm=2_2#p7HGMpc_2_2m  

Subsequently, I've had 2 female cousins and another aunt who got postmenopausal breast cancer. But remember, overall, about 13% of women will get breast cancer some time in their lifetime, my cousins were over 50, and I have a lot of female cousins.

Here's what the USPTF recommended for BRCA testing;  this assumes you have a 'usual' family tree. http://www.uspreventiveservicestaskforce.org/uspstf05/brcagen/brcagenrs.htm#clinical

Of course, the only people really qualified to evaluate your family tree are board-certified genetics counselors, and I'm definitely not qualified.

I chose to not be BRCA tested; I'd have to pay out of pocket and my risk was low.

Bessie is totally right.  Only about 15% of women who get breast cancer are thought to get breast cancer because of a single deleterious mutation.  About 70% of women who get breast cancer have no obvious causes for breast cancer (besides being a woman.)

Beesie

leaf, FYI, when I went through genetic counselling, I was asked about parents, grandparents, siblings, and aunts and uncles, and then there was an "anyone else" question specifically to cover off cousins and nieces and nephews, etc..  

Even if cousins aren't included on the form, in morningperson's case, because she has so little information available, the info on cousins could provide a clue, since they are one way to track back to her grandmother.  Generally though second (aunts, uncles, grandparents) and particularly third (cousins) degree relatives aren't given as much weight than first degree relatives (parents or siblings) when they are considering the likelihood that someone might have the BRCA genetic mutation.  

Edited for a typo in the last paragraph:  Changed from "....are given a much weight" to "aren't give as much weight"  Geez, I need to learn to proof better, even if I am in a rush!

morningperson

Thank you all for the helpful information. My paternal family is small; my uncle had one biological daughter and she died in her 30's from a drug overdose. No known cancers. My father died in his early 50's from heart disease. My uncle is still alive; I do not know if he has had any type of cancer; I've just made contact with him after many years. My sister has has not had any known cancers, although she is a walking train-wreck health-wise. So, my brca risk is extremely small; but I think it was well worth thinking through the family history. Good thing I've stayed thin, fit, and sober; in my family the genetics for heart disease and substance abuse are much more concerning than risk for inheriting brca's, lol.

leaf

Thank you for your info,Bessie.  Its good to know that different places do things differently, or at least get their information in different ways.  You have taught me much, Bessie.

exbrnxgrl

Beesie,

You made a good point that many fail to realize, "Most breast cancer is random, not genetic." I often see new posters say they have no family history of bc and seem surprised that they have bc without a family history. The instances where there is a genetic connection are only a small minority. Also, not all types of cancers are connected to the known genetic mutations and ethnicity does play a role as well.

As usual Beesie, you are a great source of info!

Caryn

Beesie

leaf, the reason I remember that the long questionnaire that I completed and mailed in prior to seeing the counsellor had the "anyone else" question is because I distinctly recall writing in the details of a cousin's cancer.  I remember digging through my emails to find the information about when he was diagnosed. I also remember wondering if I would have heard if some of my cousins had ever had cancer, since I'm not in touch with them.  The other thing that I recall about that question was that I was a bit taken aback when I read it because it also referred to nieces and nephews.  My nieces and nephews were all in their early 20s or younger at that time and I'd never thought of cancer being an issue for them.  But of course, children do get cancer and genetic mutations do affect those in their 20s. I just hadn't thought of that until I read that question.

FYI, I edited my previous note for a typo, which might change the interpretation. 

Caryn, I think because we are surrounded by breast cancer on this board, we learn a lot about it.  But out there in the real world, the communications about BC really aren't very clear.  I too see a lot of women who come here surprised that they've been diagnosed because there is no BC in their family.  Or surprised because "I've always been healthy and I do everything right...".  Most women don't realize that the number one risk factor for getting breast cancer is being a woman.  The number two risk factor for getting breast cancer is getting older.  There's not much we can do about either of those risk factors.... the first was determined for us before we were born and the second is what we all hope for, i.e. to live long lives and get older.

Morningperson, if you want to investigate your family history further, you might want to schedule an appointment to see a genetic counsellor.  He or she will go through your family history and will be able to give you some perspective on your risk.  

morningperson

Thanks again, bessie and everyone. This thread is very helpful, and I'm getting a much clearer picture of how random BC usually is.