Breast Cancer

​What are some ways to reduce the risks of breast cancer?

There is no sure way to prevent breast cancer, but the risks can be lowered. These include modifying the risk factors which we have control over such as:

• Exercise and increasing physical activity
• Limiting alcohol intake
• Keeping a healthy diet to prevent obesity, especially post-menopause
• Cease smoking. Smoking increases the risk of many other cancers and is bad for overall health. There are suggestions of links between smoking and breast cancer
• Have more children if one is able to
  
• Breastfeeding is also protective
• Limit the use of HRT and OCP
• Limit your exposure to environmental pollution and radiation such as the use of medical imaging like computerised tomography (CT) scans unless really necessary

In high-risk women, such as those with a very strong family history or have genetic mutations such as the BRCA, risk-reducing options include taking drugs or having surgery that can reduce their risk. Risk-reducing surgeries include removal of the breast (mastectomy) and removal of the ovaries.

An alternative management strategy to risk-reduction methods is close surveillance. While this does not reduce the risk of cancer development, it does improve outcome by discovering the cancers in earlier stages, allowing earlier treatment and hence better outcomes.

Genetic Risk Assessment for Hereditary Breast Cancer & Implications

What is Hereditary Breast and Ovarian Cancer (HBOC) syndrome?

About 5 to 10 percent of breast cancers can be attributed to hereditary breast and ovarian cancer (HBOC) syndrome. Genetic change (mutation) in the BRCA1 or BRCA2 gene is the most common cause of Hereditary Breast and Ovarian Cancer (HBOC).

Individuals with BRCA1 or BRCA2 mutation tend to develop cancer at an earlier age than the general population and have higher risk for bilateral breast cancer, a second primary tumour in a different tissue, and cancer recurrence.

Mutations in other less common genes have also been found to increase the risk of developing breast and other cancers.

Who might be at risk?

Hereditary Breast and Ovarian Cancer (HBOC) is an adult-onset, cancer predisposition syndrome which can be passed down through generations.

The history of cancer in your close relatives is a clue about the chance of HBOC syndrome in your family. It is more likely if one or more of the following features can be confirmed in your family:

• Young age of onset
• Bilateral breast cancer or personal history of multiple cancers
• Family history of ovarian, peritoneal, fallopian tube, pancreatic cancers and/or melanoma
• History of male breast cancer in the family

How is Hereditary Breast and Ovarian Cancer (HBOC) syndrome diagnosed?

Genetic testing for Hereditary Breast and Ovarian Cancer (HBOC) syndrome is a blood test that is available at the Cancer Genetics Service at NCCS when specific criteria are met. Genetic testing is complex, thus it does not take place without genetic counselling and the process of informed consent.

What does genetic counselling involve?

Cancer genetic counselling is a process to assess a person's risk of having an inherited susceptibility to cancer. It is usually provided by a genetic counsellor and/or cancer geneticist to help people understand and adapt to the medical, psychological and familial implications of genetic contributions to cancer.

Genetic counselling can help you better understand the outcomes and impacts of genetic testing and the possible implications when finding a genetic mutation of Hereditary Breast and Ovarian Cancer (HBOC) syndrome.

What can I do to reduce my risk of developing breast or ovarian cancer if I have a BRCA gene mutation?

Increased surveillance (clinical breast exam, mammogram and MRI) and consideration of risk-reducing interventions (such as chemoprevention and preventive mastectomy or oophorectomy) are recommended.

What should I do if I am concerned?

If your family history of cancer suggests Hereditary Breast and Ovarian Cancer (HBOC) syndrome, please talk to your doctor regarding your concerns and they will make the necessary arrangements if a genetic risk assessment is needed.

What are the implications of genetic testing for HBOC?

Finding a genetic mutation of Hereditary Breast and Ovarian Cancer (HBOC) syndrome may help to:

• Inform family members about their own cancer risk
• Direct appropriate cancer screening and risk-reduction options for affected patients and family, and avoid unnecessary testing in those who do not require increased surveillance
• Explain the history of cancer in a family