MANY women are concerned because they have a family history of breast cancer. The fear may hamper their prospects of a long and full life.

Does breast cancer run in families?

If you have a close relative “” your mother, sister, or daughter, who developed breast cancer before the age of 50 “”, you are at a moderately increased risk of developing cancer yourself. If your mother had breast cancer at 40 years of age, you should go for regular check-ups starting at 30 years. If your relative was more distant or elderly when she developed breast cancer, you are not considered at greater risk.

Is there any risk assessment index?

Yes. The Gail Risk Assessment Index is used to estimate an individual”™s risk of breast cancer. Various factors taken into consideration are age, age at the first period, age at the first live birth, the number of breast biopsies, family history and race. The assessment index in high-risk individuals can help in deciding about chemoprevention. Chemoprevention is not recommended for women at low risk.

What advice would you give regarding mammography?

Screening young woman with a family history will detect cancers at an early stage, and a survival benefit may be expected. However, several studies have shown that the sensitivity and specificity of mammography are lower for women with a family history of breast cancer. The patients should be made aware of the limited evidence and the potential disadvantages of mammography, especially the radiation risk. Early results with magnetic resonance imaging have shown higher sensitivity and specificity than mammography. After holding discussions with women, mammography screening becomes appropriate and beneficial. The women concerned should be involved in the decision-making process.

What is the role of genetic mutation testing?

Genetic testing in higher risk patients to target mutation carriers is possible for increased surveillance. Such surveillance will enhance early detection of breast cancer. The ultimate goal is the ability to manipulate the mutations and prevent breast cancer in these high-risk patients.

The discovery of genes has led to the identification of women who carry a mutation and are at a very high risk of the disease. However, this facility is only available as a research tool.

What is screen-detected cancer?

There is an abnormality on the x-ray of breast which cannot be felt. The only way to accurately define its nature is to insert a guide wire under x-ray control into this abnormality. This is not painful but is a little uncomfortable. Whether or not further surgery is required depends upon the results of the microscopic examination.

What is chemoprevention?

Chemoprevention refers to the use of medications to reduce a person”™s chance of developing cancer. Oestrogen plays an important role in the development of breast cancer. Drugs that can block the action of oestrogens have been studied to see if they can prevent breast cancer.

What is Tamoxifen?

Tamoxifen can affect the growth of cancer cells by blocking oestrogen. Women with early breast cancer who take Tamoxifen have a reduced risk of recurrent breast cancer. Women treated with Tamoxifen have a reduced risk of cancer in the opposite breast. Those with a higher risk of breast cancer who take Tamoxifen had a significant reduction in breast cancer events.

What are the risks of Tamoxifen therapy?

Tamoxifen is a well tried and effective drug that has a very low incidence of side effects. Women taking Tamoxifen are more likely to experience problems with stroke and blood clots in the lungs or leg veins, an increase in cases of uterine cancer, hot flushes and vaginal dryness. These occur predominantly in women older than 50 years. Overall, the beneficial effects outweigh the adverse effects.

What is the role of prophylactic mastectomy?

Bilateral prophylactic mastectomy (removal of breasts) greatly reduces the risk of breast cancer, and prophylactic mastectomy is predicted to increase the life expectancy of carriers of genetic mutations. Techniques of mastectomy are now available which improve the aesthetic result without compromising the principles of cancer surgery.

The fear of cancer should not stand in the way of your dreams. Recent advances and newer technologies offer a better chance by substantially reducing the risk of death. Newer drugs are being tested. These can be more effective and less toxic.

Dr Wig is a renowned surgeon who gives advice to The Tribune readers regularly.