The Morning Journal (Lorain, OH)

Does all family history increase breast cancer risk?

- Contact Dr. Roach at ToYourGood­Health@med. cornell.edu.

DEAR DR. ROACH »

I am a 24-year-old woman. My mother had ductal carcinoma in situ in her mid-40s, successful­ly treated with surgery and radiation. One of my paternal aunts survived a malignant breast cancer. Am I considered high risk for breast cancer? I know my mom’s cancer increases my risk, but does DCIS increase the risk level as much as a malignant cancer? When should I start undergoing mammograms or other screening?

— C.P.

DEAR READER » Ductal carcinoma in situ is a breast cancer that is entirely contained within the mammary ducts of the breast. Something like half of women with DCIS will develop invasive ductal cancer of the breast if untreated, so women with DCIS are recommende­d treatment, either a mastectomy or a breast-sparing treatment regimen, such as a “lumpectomy,” often followed by radiation treatment. With treatment, DCIS has an excellent prognosis, with a 20-year risk of dying from breast cancer of about 3%. Much research is going on to determine which women with DCIS need more aggressive treatment and who can be spared treatment that would ultimately be unnecessar­y in their cases.

DCIS and invasive intraducta­l breast cancer share genetic susceptibi­lity, so it is clear that a family history of DCIS means you are at higher risk for developing both DCIS and invasive breast cancer yourself. However, that risk may be lower than you think. The National Institutes of Health’s standard risk calculator (called the Gail model, available at https://bcrisktool.cancer.gov/calculator.html) is used to estimate risk. There isn’t data for someone as young as you, but a 35-year-old woman with one first-degree relative — mother, sister or daughter (an aunt does not significan­tly increase risk) — with invasive breast cancer has a lifetime risk of about 19.2%, compared with 12.6% for a woman with no family history. I could not find exact numbers for your situation, but the percentage will be somewhere in between the 19.2% and 12.6% numbers.

Screening for woman at average risk should begin by age 50, but some women choose to begin at age 40. Almost half of women screened yearly in their 40s will have a false positive mammogram, which requires follow-up studies and often a biopsy, with all the anxiety, cost and discomfort associated. Many women choose to take the risk of the false positive to have even a small decreased risk of dying from breast cancer; others prefer to wait until age 50, when mammograms are more accurate and the incidence of breast cancer is higher.

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