| Posted October 6, 2014 | By Bernie Burgess, M.D. | Categorized under Women's Health |

One of the most frequently asked questions in my office pertaining to breast cancer revolves around family history. Although that is an important factor to take into consideration, breast cancer is only hereditary about 15 to 20 percent of the time.

Having a family history does increase your risk of developing breast cancer, but it's not as high of a risk as many might think. It is only a slight increase in risk, but it is still a risk factor that deserves attention.

All in the family

Family history is important in everything pertaining to our health. That's why we all get colonoscopies or any other test of that nature.

But true, hereditary cancer only happens about 15 percent of the time. The remaining cancer cases are sporadic. It just happens. When we ask about family history of breast cancer, a direct relative who has had it increases your probability of getting it, but it's still a small percentage.

However, we can't overlook the fact that every woman is at risk. Family history is a risk factor just like not having children, being older, being obese, or being on estrogen therapy are all risk factors. One in eight women will develop breast cancer. If you are a woman, you are at risk.

Some good news

We are oftentimes finding breast cancer sooner than we ever did before because our screening techniques are so much better than in the past. Digital mammography and needle biopsies are changing the game.

With digital mammography, there is much more clarity in what we can see. It is like the difference in watching an old TV and one that is hi-def. It makes it much easier for us to see if things are different than they should be.

Further, thanks to needle biopsies, we are able to get a sample of the tissue without having to go into surgery. We are doing more biopsies for benign disease because we can see more than we ever did before, but also diagnosing pre-cancerous and cancerous tissues earlier.

Surgical advances

Surgery is recommended 100 percent of the time with breast cancer ranging from a lumpectomy to a bilateral mastectomy with reconstruction. There are multiple options once a diagnosis is made, but we will do surgery of some sort every time. Due to advances in cosmetics and techniques, double mastectomies and reconstruction have better outcomes than they did a decade ago.

We are now able to do a skin-sparing mastectomy, which means you don't take as much skin, so the result looks much more natural. There is also a nipple-sparing mastectomy, where if the cancer isn't too large or too close we can save the nipple, again resulting in a much more natural reconstruction.

Diagnosing lymph node spread is also less invasive and does not involve the removal of as many nodes as before. What we've learned is taking lymph nodes out is more of a diagnostic procedure than a therapeutic procedure. Treatment isn't going to change and a patient's survival rate will not change by taking more nodes, so it's easier on the patient to take less nodes because of complications that can be associated with taking more out.

BRCA

Many women have heard of the BRCA test, which detects the presence of a gene that is linked to hereditary cancer. This is a great test if you have direct relatives who have had cancer. If a woman tests positive for the gene, it means her children have a 50 percent chance of also having the gene.

I caution women to think about what they are going to do with the information they get from the test. If you aren't prepared to make a decision, then what are we going to do with the information we get? If you do have a positive BRCA test, that only constitutes 5 to 10 percent of all breast cancers.

The test can also be expensive, ranging from hundreds to thousands of dollars and is only covered by insurance if you have a history of breast cancer in more than one first-degree relative or an extreme case, such as a diagnosis of cancer in both breasts. So it's important to check with your insurance company before you decide to have the test.

Choices

If you have the gene that is detected through a BRCA test, your chances of developing breast cancer increase 80 percent by age 70. This news has prompted many women to have surgery to remove breast tissue before there is any cancer detected, just to eliminate any risk that might exist. This is what is called a prophylactic mastectomy. Other options if you are at risk are closer follow up and use of MRI as a means of detection.

Some may see this as radical, but peace of mind is one of the most important things we give women as surgeons and people treating breast cancer. If a woman is going to worry and lose sleep over this information, I do not try to dissuade them unless I believe it is a very drastic measure. I am not the one who lives with it everyday.