Prospective surveillance of women with a family history of breast cancer: auditing the risk threshold

Breast cancer risk scores in a standard screening population

SUMMARY Aim: Information regarding the characteristics and breast cancer risk factors of British women in the standard population attending breast cancer screening is limited. Such information could be useful in personalizing screening and care, and informing and educating women about their risk. Materials & methods: Information about various breast cancer risk factors was obtained from 355 women aged between 46 and 74 years at a UK inner-city breast cancer screening clinic using questionnaires. The risk of breast cancer was calculated using the modified Gail model and analyzed using descriptive and regression statistics. Results: There were 26 women recalled for further assessment and two cases confirmed as invasive breast cancer. Forty-seven women reported first-degree relatives with breast cancer. A total of 58% of our sample was overweight or obese, although 84% reported meeting the recommended target of ≥150 min of exercise per week. A total of 44% were smokers and 23% reported consuming alcohol on a regular basis. The mean lifetime risk score was 9.0% and the mean 5-year risk score was 1.5%. Various non-Gail model risk factors were found to be correlated with risk scores, but the only factor that was significantly different between women recalled for further assessment and those who were not was age of menarche. Conclusion: The results suggest that determining risk factor data in a standard screening population could be useful both to the women, who may have modifiable lifestyle factors that can be changed to improve their risk, and to the clinics, which can identify women at a higher risk who may be unaware and not present themselves as candidates for risk assessment.

[Hereditary breast and ovarian cancers]

Hereditary factors are responsible for 5-10% of all breast cancers and 10% of all ovarian cancer cases and are predominantly caused by mutations in the high risk genes BRCA1 and BRCA2 (BRCA: breast cancer). Additional moderate and low penetrance gene variants are currently being analyzed via whole genome association studies. Interdisciplinary counseling, quality managed genetic testing and intensified prevention efforts in specialized medical centres are essential for members of high risk families considering the high prevalence of malignant tumors and the early age of onset. Furthermore, the identification of BRCA-deficient carcinomas is of particular clinical interest, especially regarding new specific therapeutic options, e.g. treatment with poly (ADP-ribose) polymerase (PARP) inhibitors. There are presently no valid surrogate markers verifying the association of BRCA1/BRC2 in tumors. However, breast cancers harboring pathogenic BRCA1 mutations in particular display specific histopathological features.