Management of familial breast cancer risk

Women who are members of breast cancer families are at increased risk for b reast cancer. The cloning of BRCA1 and BRCA2 has made it possible to identi fy mutation carriers within some of these families. Management of breast ca ncer risk in these families, which presents enormous challenges to patients and clinicians, is addressed. Management should begin with a full evaluati on of the patient, including construction of a three-generation pedigree, a scertainment of non-genetic factors that may impact on risk, information on previous and current breast health, practice of and attitudes toward scree ning, and the psychosocial impact of family history on the individual. Pati ent priorities in risk management should be explicitly reviewed; these may include survival, cancer prevention, breast preservation, optimization of q uality of life or minimization of disruption of day-to-day activities. Appr oaches to risk management involve screening (usually considered the mainsta y), anti-estrogens, prophylactic surgery and/or lifestyle modifications. Sp ecific gene therapy may become available in the future. Management decision s should be individualized to reflect risk levels and patient priorities an d goals, within bounds that are medically and scientifically reasonable. An explicit examination of different time-frames (1, 5, 10 years) is recommen ded given the rapid evolution of knowledge in this area.