In an age where medical advancement and genetic testing is rapidly growing, doctors still rely on a old trusted and true method for predicting whether a woman is at risk for breast cancer more than anything else — family history.

“If a woman has questions about whether she has an increased rate for breast cancer, family history is the biggest tool used by doctors,” according to Heather Rocha, a genetic counselor at Geisinger Medical Center, Danville.

When it comes to family history, Rocha said one thing many women don’t think about is their dad’s side of the family. They associate breast cancer with their mother’s side of the family, but their dad’s side is 50 percent of the puzzle.

“A lot of women say, ‘Oh no, it was dad’s sister that had breast cancer in her 30s.’ Men can have this BRCA mutation but it doesn’t affect them the same way,” she explained.

Rocha said Dr. Rosemary Leeming, chief medical officer, helped develop Geisinger’s High-Risk Breast Clinic where different women’s risk profiles can be taken into account and testing can be done to discover if the woman has a BRCA gene mutation. Identifying mutations tells doctors if a woman has developed a higher risk for breast cancer and can lead to risk prevention.

If the BRCA gene mutation is found, there are several options that can be provided for women, including annual mammograms, a breast MRI or clinical physical exams by a doctor. Dense breast tissue makes mammograms more difficult to read, so further screenings can be provided at High-Risk Breast Clinic.

Those at a higher risk may be prescribed chemotherapy prevention drugs such as Tamoxifen, which can reduce the risk over a certain amount of years. The drug block the actions of estrogen certain breast cancer types require to grow.

Removal of the ovaries reduces the chance of breast cancer for women whose risk evaluation show their chances of developing the disease have grown. Rocha said the uterus doesn’t need to be removed, but the surgery should be done pre-menopausal.

When discussing risks, Rocha said the BRCA gene mutation is the tip of the ice burg because they’ve known the most about it for the longest amount of time, but Geisinger tests 11 different genes while screening for breast cancer.

Rocha said the start of a screening protocol is dependent upon found genetic mutations. Geisinger has certain ages in which they start screening, but it’s truly based on family history.

“Most women have their first breast MRI at 25 and clinical exams are recommended before that. For most other women who do not have genetic risk factors, we start screening using mammograms 10 years prior to the earlier diagnosis in the family,” said Rocha.

The risk of getting cancer goes up a little bit each year and as a woman ages, her chances of getting breast cancer become higher.

“If a woman has family history of early breast cancer on either side, I would encourage them to ask their doctor to send them to the High-Risk Breast Clinic,” said Rocha. “Genetic testing can be helpful, but that’s not the only risk. The clinic will address so many other aspects of risks such as breast density, menopause and cycle history.

Rocha recommends women without health insurance between the ages of 40 and 64 to visit, a Pennsylvania Department of Health program that allows women to get screenings and mammograms at no cost.


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