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
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%
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.