Prevention and Wellness

Breast Cancer and Genetic Counseling

Faith Callif-Daley, MS, LGC, genetic counselor, Miami Valley Hospital North , answers Frequently Asked Questions about breast cancer and genetic counseling.

Does previously being diagnosed with breast cancer increase a patient’s risk of developing breast cancer again?

If you have been diagnosed with breast cancer you have a slightly increased risk of developing a second cancer. If your cancer is inherited, you have a larger risk of a second cancer.

When doctors are caring for someone with breast cancer, it is important to think about inherited cancers, before an initial surgery, because having an inherited cancer may lead to a different decision for the patient upfront. The patient may choose a surgery that could take care of the cancer they have and prevent a future cancer.

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What is triple negative breast cancer?

Between 10 and 20 percent of breast cancers are “triple negative,” says BreastCancer.org, and this type of breast cancer is more often diagnosed in women with inherited breast cancer. This means that the breast cancer cells test negative for estrogen and progesterone receptors and that the HER2 gene is not making too many copies of itself.

Certain treatments are not recommended for patients with triple negative breast cancer. For instance, triple negative breast cancer will not respond to hormonal therapy like Tamoxifen, or treatments like Herceptin, which target HER2 over-amplification. There are other medicines, including some types of chemotherapy, that are valuable in the treatment of triple negative breast cancer.

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How does having a close relative with triple negative breast cancer - versus a different type of breast cancer - affect a person’s risk for breast cancer?

It is a clue that the cancer could be inherited, placing a relative with that gene mutation at higher risk. In the general population, there is a 5 to 10 percent chance that breast cancer is hereditary. Among women with triple negative breast cancer, the chance of hereditary breast cancer can be closer to 30 percent.

Why does it make a difference in breast cancer risk if someone has Ashkenazi Jewish ancestry?

We all have susceptibilities to certain diseases based on our backgrounds. In this group of Eastern European and Russian Jewish individuals, there is a higher incidence of hereditary breast cancer. In the general population, mutations in the most common genes associated with inherited breast cancer, BRCA1 and BRCA2, occur in about 1 in 800 women. For people with Ashkenazi Jewish ancestry, the incidence is 3 percent, or 24 in every 800 individuals.

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Does being diagnosed with ovarian cancer increase a patient’s risk of developing breast cancer?

Women with the most common form of hereditary ovarian cancer are also at increased risk for breast cancer. Every single woman with ovarian cancer that originates in the epithelium, or the thin tissue surrounding the ovary, should be offered BRCA1 and BRCA2 testing as a standard of care, according to National Comprehensive Cancer Network guidelines. This is partly related to increased risk for subsequent breast cancer risk, but it may also be important for treatment of ovarian cancer. There are certain medicines that may be more useful than others as part of the care of women with ovarian cancer who have a mutation in BRCA1 or BRCA2.

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Does being diagnosed with pancreatic cancer increase a patient’s risk of developing breast cancer?

If we see both breast and pancreatic cancers in a family, it can be a clue that cancer in the family is inherited.

If close relatives have been diagnosed with other types of cancers, does this increase a person’s risk for breast cancer?

There is an art to interpreting family history. Multiple types of cancers can occur in the same family because of shared environment, common genetic risk factors or by chance. If people have multiple family members with different types of cancers, it is probably a good idea to have an evaluation with a genetic counselor.

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Are there specific cancers associated with an increased risk of breast cancer?

Ovarian cancer is most often linked to an increased risk of breast cancer. A family history that includes any of the following cancers may also be a clue that cancer is inherited: pancreatic, prostate, melanoma, sarcoma, thyroid.

What defines close relatives for purposes of determining breast cancer risk?

When analyzing whether cancer could be inherited, it’s important to evaluate close relatives on both mom’s and dad’s sides of the family. Our close relatives are our first, second and third degree relatives.

People you share 50 percent of your DNA with, such as siblings, parents and children, are your first-degree relatives.

Nieces, nephews, aunts, uncles and grandparents – people with whom you share 25 percent of your DNA – are second-degree relatives.

First cousins, great-grandparents and great aunts and uncles – people with whom you share 12.5 percent of your DNA - are your third-degree relatives.

Does having a male relative diagnosed with breast cancer increase a person’s risk of developing breast cancer?

Individuals with a first- or second-degree relative with male breast cancer should be evaluated for hereditary susceptibility to breast cancer. This can be a clue to an increased cancer risk.

What are the risks of breast cancer for men?

If a man has the BRCA1 or BRCA2 mutation, he has a 6 percent chance of getting breast cancer compared to a 1 percent chance for the average man.

Every man with breast cancer should be offered genetic testing.

All men can benefit from self-checks of the chest and breast area and should report any changes of concern to their physicians. Men with hereditary susceptibility to breast cancer could benefit from additional evaluations with a physician.

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If you have a close relative who was diagnosed with breast cancer at age 50 or younger, do you have a higher risk for breast cancer?

There are multiple factors, including age of affected relatives, that can affect breast cancer risk. The younger a person is when they get cancer, the more likely it is to be inherited.

Does it make a difference to your breast cancer risk if relatives on your father’s side had breast cancer versus relatives on your mother’s side?

Breast cancer history on both sides of the family is important.

Why does age matter with a family member’s breast cancer diagnosis?

Age is a risk factor for many cancers, including breast cancer. The older we get, the more the risk for developing cancer increases, but early age of onset can be a clue that a genetic factor is present.

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What screenings are recommended if someone has a high breast cancer risk due to family history?

Mammograms keep getting better and are always important. Breast MRI can be used in addition to mammograms.

Today’s technology allows for special checks of dense breast tissue and 3D mammograms — tests that can more easily and quickly find signs of cancer in the early stages.

If someone is defined as high risk, they are screened every six months, alternating with a mammogram and breast MRI.

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How does radiation therapy to the chest because of Hodgkin’s disease affect a patient’s risk for breast cancer?

It is the combination of having radiation, the timing – in terms of a person’s development – and the amount of time the radiation was administered.

Many times radiation is necessary to treat Hodgkin’s, but a long-term effect is that it increases breast cancer risk.

Women in that category are followed very closely and men who were treated for Hodgkin’s also need to be aware of it.

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If you have no family history of breast cancer or other cancers, are you at a lower risk for breast cancer?

If there is no family history, a woman has a 1 in 8 lifetime risk of developing breast cancer, a reminder that any of us could have errors in cell division leading to cancer risk.


Source: Faith Callif-Daley, MS, LGC, genetic counselor, Good Samaritan Hospital (Miami Valley Hospital North as of July 23, 2018); Breastcancer.org; Komen.org, Cancer.gov, Centers for Disease Control and Prevention

Content Updated: July 17, 2018

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