Breast cancer family history

Martino S, Disch D, Dowsett S, Mershon J (2005b) Raloxifene and Breast Cancer Risk Reduction based on Breast Cancer Family History. Abstract. ASCO, San Francisco... 

Because the WHI is the best evidence to date linking HRT with breast cancer, women with a personal history of breast cancer and possibly even a strong family history of breast cancer should avoid the use of HRT and consider non-hormonal alternatives for the treatment of vasomotor symptoms. 

Both personal and family histories influence a woman s risk of developing breast cancer. A past medical history for breast cancer is associated with about a fivefold increased risk of... 

It has been recognized for some time that a family history of breast cancer is associated rather strongly with a woman s own risk for developing the disease. The percentage of all breast cancers in the population that can be attributed to family history range between 6% and 12%.8 Empirical estimates of the risks associated with particular patterns of family history of breast cancer indicate the following 8... 

Garber, J. (1999), A 40-year-old woman with a strong family history of breast cancer ,/ Am. Med. Assoc., 282, 1953-1960. 

The choice to use CHCs should not be affected by the presence of benign breast disease or a family history of breast cancer with either mutation. The WHO precautions state that women with recent personal history of breast cancer should not use CHCs, but that CHCs can be considered in women without evidence of disease for 5 years. 

Three other studies were conducted to investigate the preventive potential of tamoxifen. One in Italy (Veronesi et al. 1998), one at the Royal Marsden Hospital, United Kingdom (Powles et al. 1998), and a multicentric international study (IBIS 2002). The British study was the smallest in size (2471 participants) but concentrated on women with a high incidence of family history and consequently presented a higher number of breast cancers. The Italian trial included only women with previous hysterectomy and, accordingly, around 50% had also undergone bilateral oophorectomy. The family risk was low only 15% had a first-degree relative affected by breast cancer. Both European studies permitted concurrent HRT, and 26% of the participants in the British trial received HRT while on study and 42% had ever received HT for menopausal symptoms. Neither of the studies showed any positive effect of the treatment with tamoxifen on the incidence of breast cancer. Reasons for this lack of effect can be different for each trial. 

Close clinical surveillance of all women taking OCs is essential they should be reexamined at least once a year. In all cases of undiagnosed persistent or recurrent abnormal vaginal bleeding, rule out malignancy. Monitor women with a strong family history of breast cancer or who have breast nodules, fibrocystic disease of the breast, cervical dysplasia, or abnormal mammograms. 

Osteosarcoma has recently been diagnosed in a 12-year-old girl. Family history indicates that her paternal aunt died of breast cancer at age 29 after having survived treatment for an adrenocortical carcinoma. An uncle died of a brain tumor at age 38 and the patient s father, age 35, has leukemia. 

A further follow-up and analysis of 3879 women, taken from two earlier US studies, who had been exposed to diethylstilbestrol during pregnancy has been presented (42). The results showed a modest association between diethylstilbestrol exposure and the risk of breast cancer (RR = 1.27 95% Cl = 1.07,1.52). The increased risk was not further aggravated by a family history of breast cancer, by use of oral contraceptives, or by HRT. There was no evidence that diethylstilbestrol was associated with a raised risk of ovarian, endometrial, or other hormone-associated cancers. 

It is clear from the studies reported in Table 1 (133-149) that there is no simple relation between treatment with hormonal oral contraceptives and the incidence of breast cancer. As in the case of other neoplasms, studies are confounded by the influence of many factors, including age, parity, age at first delivery, family history, pre-existent fibrocystic disease, geographical or... 

There are some circumstances in which it is prudent to avoid using oral contraceptives, or in which frequent control of the state of the breasts is essential. These include (a) very long-term use before the first full pregnancy (b) prolonged use of high-dose formulations (c) uninterrupted use in women with a family history of breast cancer or with a personal history of fibroadenoma. 

Estimates from multiple logistic regression models including terms for age, study center, year of interview, education, parity, oral contraceptive use, and family history of ovarian and/or breast cancer and energy intake, according to the residual model. b Reference category. 

T.A. Sellers, et al., The role of hormone replacement therapy in the risk for breast cancer and total mortality in women with a family history of breast cancer. Ann. Intern. Med. 127 973-980, 1997. 

The risks and benefits of HRT should be carefully assessed on an individual basis. This is particularly important in women with predisposing risk factors, such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity or prolonged bed-rest [2], because HRT increases the risk of venous thromboembolism and stroke. HRT has also been observed to increase the risk of gallbladder disease, breast cancer and endometrial cancer. It is recommended that the minimum effective dose should be used for the shortest period of time, with treatment being reviewed at least once a year [2]. 

The strongest risk factors for breast cancer are female gender and increasing age. Additional risk factors include endocrine factors (e.g., early menarche, nulliparity, late age at first birth, hormone replacement therapy), genetic factors (e.g., personal and family history, mutations of tumor suppresser genes [BRCAl and BRCA2]), and environmental and lifestyle factors (e.g., radiation exposure). 

Carcinoma of the breast can occur with any type of HRT. Some 45 in every 1000 women aged 50 years will have breast cancer over the next 20 years, rising by only 2,6 and 12 cases, respectively, for women who take HRT for 5, 10 or 15 years. A family history of breast cancer does not increase the risks from HRT. 

Longer-term use is more problematic, given the probable increase (though < 2-fold) in fhe risk of breast cancer associated with extended use. Reasonable candidates are the small proportion of postmenopausal women with documented osteoporosis or osteopenia (decreased bone density) or those at increased risk for osteoporosis (personal or family history of nontraumatic fracture, ciurent smokers, or those with a body-mass index < 22) who do not have a personal or family history of breast cancer or other contraindications and who are willing to try this therapy. With more long-term... 

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