What is considered high risk?

SarahsMom · December 2010

My mother had a ductal excision in her 30s, it was benign. Her sister had a double mastectomy in her early 60s. My grandma (their mother) had a partial mastectomy in her earlly 60s.

I don't have any sisters, just my mom. So far, so good! So my mom herself has not had cancer, and that my relatives had cancer in their early 60s - does this add to my risk? Most of the risk calculators just factor in moms and sisters. Thanks for any insight!

Anonymous · December 2010

your grandmother and aunt would both be considered secondary relatives, which would only increase your risk of bc slightly. (Having a primary relative (mother, sister, or daughter) would double your risk.) You probably would be considered a little higher than average risk because of it, but not exactly "high risk". But your risk would have to be calculated by many factors, not just family history. (age of first period, first childbirth, age at menopause, etc....)

Anne

dlb823 · December 2010

I believe relatives dx'd before age 40 are also considered more of a risk factor than those dx'd later in life.

The best thing to do is to speak to a genetics counselor. Based on a few questions, they will be able to tell you whether further investigation and testing is merited for your situation. Deanna

SarahsMom · December 2010

http://www.halls.md/breast/risk.htm

Thank you, ladies, I really appreciate your advice and insight! I've had prior surgery (ductal excision with atypical hyperplasia) and now I'm having an issue with a dense area on the same side that a mammo can not see into - in order to get an MRI, I had to take the Gail model test w/ my doctor. I was a 21%, and the "tolerance" level for an MRI is 15%, so I was successful. I attached the link to the model above. I am learning to be my own best advocate! Thanks to both of you and happy holidays!

leaf · December 2010

I would be VERY cautious about using the http://www.halls.md/breast/risk.htm calculator unless, perhaps, you have very ordinary conditions.

I have classical (type A) LCIS, ALH, nothing worse, and a weak family history (2 secondary relatives with breast cancer, opposite sides of family, both postmenopausal.)

Without tamoxifen or AI, at one point, I could get the calculator to tell me I had a 89% lifetime chance of breast cancer. That is about triple the risk of other sources. (Onc said about 30%, genetics counselor said 40%, 2nd opinion said 10-60% but probably closer to 10 than 60%.) I don't want people to have heart attacks, especially during the holidays.

The literature I can find estimates ROUGHLY 1% per year - since I'm in my mid 50s that can't be up to 90%. Still, because the LCIS population is still small, they really don't have accurate numbers. (Most women with LCIS are diagnosed in their late 40s or 50s.)

Dr. Hall's calculator site does say that it has not been peer reviewed or compared to the appropriate populations. That is Very Important information.

The entire subject of breast cancer prediction for an individual is in its infancy. The Gail model, and the Gail model plus the addition of other risk factors, such as breast density, can be pretty accurate in predicting how many women in a population will get breast cancer (at least in certain populations). It is VERY POOR at predicting WHICH particular women will get breast cancer. The Gail model, and its derivatives such as the Dr. Hall model, specifically say they should NOT be used to make individual treatment decisions.

The ACS in this paper was inconsistent about LCIS (it was written by a committee), but said LCIS (and nothing worse) women were NOT at high risk. http://caonline.amcancersoc.org/cgi/content/full/57/2/75 I have read articles that say that LCIS is the highest risk for breast cancer that can be seen under the microscope. The women who have a deleterious BRCA gene or relatives of someone who have a deleterious gene, chest radiation from things like Hodgkin's disease TREATMENT *are* high risk.

This 2006 medical journal editorial says the Gail model and its derivatives 'better at prediction than the toss of a coin - but not by much.' http://jnci.oxfordjournals.org/content/98/23/1673.full.pdf

If you do have a BRCA mutation or significant family history, the prediction models may be better than a coin toss, but, as Deanna said, you need to talk to a genetic counselor.

This site gives the USPTF guidelines for BRCA testing. They are only guidelines, not lines in the sand. http://www.uspreventiveservicestaskforce.org/uspstf05/brcagen/brcagenrs.htm#clinical

suca1213 · January 2011

Having a family history of breast cancer does make one eligible for similar risks. However, there are several factors, like exercise, your diet, menstrual cycles, etc. that are jointly involved. Get yourself tested periodically at a good breast cancer center. They are well equipped with all the facilities and after studying or knowing your concern, they can even suggest preventive steps. They will also recommend you the time for periodical checkups which is essential for every woman after 30.

SarahsMom · January 2011

Thanks, suca! I should have mentioned in my original post that already had one breast surgery (ductal excision w/ atypical hyperplasia) so I go in every 6 months anyhow. I'm 45 and had an emergency hyster last year, as well. I am just confused about the family connection, I've read a lot of studies that contradict each other!

37antiques · February 2011

Hi Carpediem,

They seem to change all of the risk factors frequently. My paternal post-menopausal grandmother had bc, no other relatives, but that did not stop me from a dx of pre-menopausal high grade IDC and DCIS. A radiologist told me that the paternal side did not matter, but to keep mentioning it in case the standard changed.

I guess I'm just the lucky one in the family.

Sue

SarahsMom · February 2011

Thanks, Sue. Since I posted, I was able to get into a good breast center in the area and talk to a breast surgeon who has been working in the same facility for 27 years. He told me there are still many mysteries related to breast issues and one is how it skips around the family, so he takes all female family member cancers into account, including ovarian. My paternal grandmother died from OC but I've never really mentioned that in my records before. Also, he said mastitis is another ??? since it can occur in non lactating women. At this point in his career, he said he's pretty much seen it all and it is still difficult to trend how certain cases will go. For instance, he's seen thousands of films, so you'd think over time there are patterns, that a few lone calcs will turn into a string or whatever, but apparently not so. That made me feel good because he actually listened to my concerns and didn't just dismiss me, he truly looks at each individual case and doesn't try to apply some blanket diagnosis or treatment. Unfortunately, he is retiring later this year.

Thanks again and hope you are having a nice evenign :-)

What is considered high risk?

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