Should I go for additional breast cancer screening or genetic counseling?
Jennifer Siettmann is a certified genetic counselor on staff at Banner – University Medical Center Phoenix. Her office can be reached at (602) 839-6385.
Question: There is a history of breast cancer among the women in my family. Aside from routine mammograms, should I undergo additional breast cancer screening?
Answer: There are three different categories for breast cancer, based on how it is caused: sporadic, familiar, and hereditary. Identifying where one falls in these three groups helps determine the best screening protocol.
Most cases of cancer are sporadic (50 to 60 percent), which means the cancer is due to random environmental or lifestyle factors, or just random chance. Since sporadic cancer poses an average risk of 8-13 percent, general population screening measures are appropriate, including an annual mammogram, annual clinical breast exam, and monthly self-breast exams beginning at age 40.
Familial cancer makes up 30-40 percent of diagnoses and is generally the result of a combination of genetic and environmental/lifestyle factors that contribute to an increased risks for cancer. Familial cancer poses a moderate risk for breast cancer, with a 20-50% chance of occurrence. Still, we recommend a high-risk level of screening, including annual MRI, biannual clinical breast exam, and monthly self-breast exams starting 10 years prior to the youngest age at which cancer was diagnosed in the family. So, if a mother was diagnosed with breast cancer at 43, then her daughter should start screening at age 33.
Hereditary cancer is relatively rare, accounting for 5-10 percent of cases, according to the National Cancer Institute. People who inherit a specific genetic mutation, which we can find through genetic testing, generally have a 50-80 percent risk of developing breast cancer, according to the American Cancer Society.
Due to this risk, we apply the most aggressive forms of screening and management for these individuals. Screening includes an annual mammogram, annual MRI, biannual clinical breast exam, monthly self-breast exams and genetic testing of other family members.
Genetic testing provides benefits for individuals and their families. Once a genetic mutation is identified, other family members can be tested for that same mutation. Through genetic testing of a family, we have the opportunity to see whether certain members need to be screened earlier and/or more frequently.
Being properly screened for cancer provides individuals, loved ones and care providers with invaluable knowledge. This knowledge allows us to establish an effective screening protocol, detect and diagnose cancer in a timely manner, and establish the best course of action for preventing and/or managing the disease.
If you have any questions or concerns regarding cancer screening, talk to your health care provider or a genetic counselor.