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SEVEN

Breast Cancer

Breast Cancer

Since the identifications of breast cancer

genes, BRCA1 & 2 in 1994 and 1995

respectively, a lot has been known about

the inheritance of breast cancer. However,

this is only relevant to an even smaller

number of Familial Breast Cancer. BRCA1

& 2 mutations only explain about one fifth

of those with familial disease and there

are many other unknown genes involved

in the development of breast cancer.

This indicates that the majority of women

with a family history of breast cancer fall

in the category of either those with an

average risk of developing the disease,

that is to say a similar risk of women

with no family history of breast cancer,

or only have a moderately increased risk

of the disease.

Women with an average risk of breast

cancer have about a 10% lifetime risk.

Such a risk is about 2-3 times higher for

those who are considered at moderately

increased risk. In view of this, these

women are recommended to have annual

mammographic screening from the age

of 40 to the age of national screening.

Subsequently, these women will join the

NHS Breast Screening Programme which

offers mammography every three years.

The level of risk is very different for

women with a strong family history or

those who are proven to be carriers of

BRCA1 & 2 mutations.These women

have a high lifetime risk of developing

breast cancer, up to 80%.The highest risk

is incurred by the BRCA carriers.

Age remains the most significant risk

factor for sporadic breast cancer.

However, nearly 50% of breast cancer in

carriers develops under the age of 50.

Furthermore, data has shown that such

a risk starts to rise from the age of 30

and remains higher than that in the

general population for the rest of these

women’s lives.

It is not surprising that these women

experience high levels of anxiety and,

consequently, have tough and difficult

decisions to make in their attempt to deal

with the fear of developing breast cancer.

These women have limited options,

ranging from surveillance to risk-reducing

mastectomy. Changes in lifestyle and use

of endocrine therapy may have a role

to play, however, they provide a limited

level of risk reduction.These women

are also at a significantly increased risk

of ovarian cancer. Bilateral risk reducing

salpingo-oophorectomy in premenopausal

women has consistently been shown to

reduce the risk of breast cancer by about

50%. Mastectomy, however, provides the

maximum risk reduction and data has

shown risk reduction in the order of 90%

or more.

These women need the full support

of a multidisciplinary team involving

geneticists, breast surgeons, oncologists,

reconstructive surgeons, psychologists

and breast care nurses, all of whom

have special interest in Familial Breast

Cancer. At London Bridge Hospital, we

are able to provide such specialised

care to these patients, who undoubtedly

present a challenging and complicated

medical problem.This has a significant

impact on these women, both physically

and psychologically, and such a team is

fundamental in assisting these women

to restore a good quality of life.

Familial Breast Cancer

Mr Hisham Hamed

Consultant Breast Surgeon

Cancer is common and it is estimated that one in every three individuals will develop

the disease. Breast cancer is also the most common female cancer in the western world.

There are a reported 44,000 new cases in the UK annually. It is therefore not surprising

that many women will have one or more members in their family with cancer in general,

and breast cancer in particular.

It has been shown that only 5% of all breast cancers are considered to be familial and

secondary to inheritable genetic mutation.