Hereditary breast cancer - Risk assessment of patients with a family history of breast cancer

OBJECTIVES To assist family physicians in stratifying women with a family h istory of breast cancer as being at low, moderate, or high risk of heredita ry breast cancer (HBC). To present guidelines for managing each of these. r isk groups; QUALITY OF EVIDENCE A MEDLINE search was conducted from January 1976 to Dec ember 1997 using key words related to breast cancer risk factors, risk asse ssment, prevention, and screening. Risk stratification criteria were derive d empirically and assessed using retrospective chart I review. MAIN FINDINGS Although up to 20%; of women in the general population have a family history of breast cancer, less than 5% are at high risk for HBC. Ce rtain features in a family history suggest increased risk. Women with none of thc se features are at low risk for HBC and should have annual clinical breast examinations and mammography at least every 2 years starting at age 50. Women with one or more features of increased risk who do not meet crite ria for referral to a familial cancer clinic are at moderate risk for HBC a nd should begin annual mammography and clinical breast examination at age 4 0. Women who meet referral criteria are at high risk for HBC and should be counseled regarding referral to a familial cancer clinic for more detailed risk assessment and consideration for genetic testing. All women should be taught proper breast self-examination technique and encouraged but not pres sured to practise it monthly for life. CONCLUSION A simple algorithm can assist physicians in stratifying women in to low, moderate, and high HBC risk groups. Management strategies for each group are given in this article and the two following (Heisey ct al page 11 4 and Carroll et al page 126).