Assessing Your Risk

Most women are surprised to learn that the majority of breast cancers (75%) occur in women without a family history of breast cancer. Family history is one factor that can affect your risk of getting breast cancer but there are many other factors, some that may surprise you. Approximately one in eight women will develop breast cancer over her lifetime. Given that we are all at risk of developing breast cancer, many women are interested in a careful risk assessment and counseling on how they might reduce their personal risk.

Risk Factors

There are risk factors over which we have no control. In addition to family history, age at menarche (first period), breast density, exposure to chest wall radiation during cancer treatments as a child and possibly even your height contributes to your lifetime risk of getting breast cancer. However, there are several risk factors over which we have some control. We can lower our breast cancer risk by maintaining an ideal body weight, and by pursuing a diet low in saturated fat and high in fruits and vegetables. Minimizing alcohol consumption will help reduce the risk of developing breast cancer. Women who get regular exercise may be at a lower risk for the development of breast cancer. The American Cancer Society recommends a minimum of about 2.5 hours of exercise per week, walking for 20 to 30 minutes most days will do the trick. The American Cancer Society Nutrition and Physical Activity Guide is a nice resource.

Risk Assessment Models

There are several risk assessment models available that may be helpful in assessing your risk. Each model has its strengths and weaknesses and sometimes looking at one’s risk through a variety of different models can create more confusion than clarity. But many women like to know what these models would predict and we have the ability to run all the major breast cancer risk assessment models, the Gail Model, the Claus Model, BRCAPRO, and Tyrer-Cusik version 6 and version 7, in our office.

BrevaGEN is a newer risk assessment tool. BrevaGEN Plus is a genetic based risk assessment tool for non-hereditary (sporadic) breast cancer. It looks at both clinical risk factors (the Gail model) and genetic markers known to be associated with sporadic breast cancers to then modify your risk assessment. The BrevaGEN Plus test has been validated in African American, Caucasian, and Hispanic women, ages 35 and older. Using a simple swab of the cheek, a genetic sample is taken and is tested for single nucleotide polymorphisms (SNPs). SNPs are variations in DNA and the BrevaGEN Plus test looks for specific SNPs known to be associated with an elevated breast cancer risk. The genetic result is combined with the Gail Model assessment to provide a modified 5 year and lifetime risk. Since the patient’s DNA is being used to modify the computer model’s prediction, the BrevaGENPlus test is thought to give a better estimate of an individual’s risk. A plan for how to manage that risk can then be formulated in the office. We are one of the few facilities in Alaska to offer the BrevaGen Plus test to our patients.

Genetic Testing
Depending on your specific family history, you may be a candidate for genetic testing. Every patient who is seen in our clinic is assessed to see if they meet NCCN guidelines for genetic testing. We have been providing genetic counseling and genetic testing in our office for well over 10 years. We have been leaders in the field of physician led genetic counseling and testing. This field is changing very rapidly so not only do we assess our patients at the first visit but we update them on changes to the field with ensuing visits. Our expertise allows us to keep all of our patients current with genetic testing recommendations. In the past, genetic testing for breast cancer was limited to BRCA gene testing. We sometimes call this the Angelina Jolie gene, as she has a mutation in this gene and underwent very public bilateral mastectomies to bring awareness to the issue. We now know that there are many genes that can increase one’s risk of getting breast cancer and other cancers. With modern sequencing technology, it has become fairly easy to test whole panels of genes rather than just one or 2 individual genes. So, it has become the new standard for most patients to test for a panel of genes that might increase breast cancer risk rather than to just test for the BRCA gene.

What Method is Right for You?

When you are seen for a consultation, Dr. Sandford and Nancy Nibbe, ANP will review your history and will discuss whether any of these testing methods is appropriate for you. An individual risk management plan may also be appropriate.

DISCLAIMER: Dr. Sandford and Nancy Nibbe do not provide online medical advice. The information provided is for general information only.