Study Shows Family History May Not Be So Useful in Predicting Breast Cancer Risk

Family history is a much poorer predictor of early breast cancer risk than most women realize, say researchers whose latest study argues against using family history alone to determine a young woman's risk for the disease.

When they examined the predictive value of family history for assessing breast cancer risk early in life, researchers from Leiden University Medical Center in the Netherlands found little correlation between family history and breast cancer incidence at a population level.

A predictive model developed by the researchers found that roughly one in 10 women with a strong family history of the disease could be expected to develop breast cancer before the age of 50 and just one in 100 would develop the disease before their 30th birthday.

The findings suggest that too many women may be undergoing genetic testing and close surveillance for breast cancer based on family history, the researchers say.

"Applying family history related criteria results in the screening of many women who will not develop breast cancer at an early age," epidemiologist Geertruida H. de Bock and colleagues write in the latest issue of BMC Cancer.

Family History of Breast Cancer
According to the American Cancer Society, a family history of breast cancer does increase a woman's risk of breast cancer. This risk is higher in women whose close relatives (maternal and paternal relatives) have the disease. Having a mother, sister, or daughter with breast cancer approximately doubles a woman's risk, even though 70% to 80% of women with breast cancer do not have a family history.

A family history of breast cancer is not the same as breast cancer risk associated with the inherited mutations of BRCA1 or BRCA2 genes.

In an effort to better understand the predictive value of family breast cancer history, de Bock analyzed its impact in close to 2,000 women with and without breast cancer.

Breast cancer risk was assessed based on four accepted indicators of family risk:

Having at least two female first-degree relatives (sister, mother, or daughter) with breast cancer.
Having at least two female relatives -- either first- or second-degree -- diagnosed with breast cancer before the age of 50. Second-degree relatives include grandmothers, aunts, and nieces.
Having at least one female first- or second-degree relative diagnosed before the age of 40.
Having a relative with a diagnosis of breast cancer in both breasts.
Women with only one first-degree relative diagnosed with breast cancer before the age of 50 were not found to be at increased risk for developing breast cancer early in life.

The researchers concluded that women with none of these family risk factors or just one of them had a very small risk of developing breast cancer early in life and would probably not benefit from genetic testing or intensive early screening.

At the population level, risk was still relatively low for women with two or more family risk indicators.

"Due to the low prevalence of early breast cancer in the population, the predictive value of family history of breast cancer was 13% before the age of 70, 11% before the age of 50, and 1% before the age of 30," de Bock notes in a press statement.

Many Women Overestimate Risk
The findings suggest that most women with a family history of breast cancer have little to worry about.

That comes as no surprise to Debbie Saslow, PhD, who is director of breast and gynecologic cancers for the American Cancer Society (ACS).

"Even a woman who is 35 with a mother who had breast cancer in her 30s and an aunt who had it in her 40s may be just borderline high risk," she tells WebMD. "You really do have to have a significant family history to be considered high risk."

Assessing family-related breast cancer risk is very complicated, and Saslow recommends seeking the help of a medical professional who has experience with risk-assessment tools.

The ACS also recommends that women who are considering genetic testing first talk to a genetic counselor, nurse, or doctor qualified to explain and interpret the test results.

Saslow agrees that many women may be overestimating their breast cancer risk based on family history.

She adds that companies that promote genetic testing for breast cancer may be part of the problem.

"Some of these companies recommend that anyone with even one relative who had breast cancer before the age of 50 should be tested," she says. "That is just not justified."


source: http://www.webmd.com/breast-cancer/news/20080722/family-poor-predictor-of-breast-cancer?page=2

No Need For Gene Screens In Breast Cancer Families, Study Shows

Research reported today should provide relief to women who are worried after a relative's breast cancer diagnosis. The study shows that a family history of breast cancer does not give a useful indication of the likelihood that a woman will develop it herself at an early age.

An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies. As physicians and the general population have become more aware of this increased risk, the demand for referring healthy women with a family history of breast cancer for intensive screening or genetic testing has risen. Geertruida H. de Bock led a team from Leiden University Medical Centre in the Netherlands who investigated whether the increased risk was significant enough to accurately predict breast cancer.

According to de Bock, "Due to the low prevalence of early breast cancer in the population, the predictive value of a family history of breast cancer was 13% before the age of 70, 11% before the age of 50, and 1% before the age of 30." These numbers are much lower than most women would probably expect. As the authors explain, "Applying family history related criteria results in the screening of many women who will not develop breast cancer at an early age."

Given the psychological harm that screening visits can cause, more stringent criteria should be applied to early screening. The researchers recommend that these results be used to "reassure a large number of women regarding their personal breast cancer risk."


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Journal reference:

1.Geertruida H De Bock, Catharina E Jacobi, Caroline Seynaeve, Elly M.M. Krol-Warmerdam, Jannet Blom, Christi J. Van Asperen, Cees J. Cornelisse, Jan G.M. Klijn, Peter Devilee, Rob A.E.M. Tollenaar, Cecile T.M Brekelmans and Johannes C. Van Houwelingen. A family history of breast cancer will not predict female early onset breast cancer in a population-based setting. BMC Cancer (in press), (in press)
Adapted from materials provided by BMC Cancer, via EurekAlert!, a service of AAAS

source: http://www.sciencedaily.com/releases/2008/07/080722192348.htm

Increase in Breast Cancer Among Alaska Native Women Appears To Be Slowing, Researchers Say

The 30-year increase in breast cancer rates among Alaska Native women appears to be leveling off, according to researchers making a presentation on Tuesday at a cancer symposium in Anchorage, Alaska, the Anchorage Daily News reports.

Breast cancer once was a rare occurrence among Alaska Native women, but the group's rate in Alaska now equals the rate of white women nationwide and is 50% higher than that of American Indians and Alaska Natives who live in other states, according to the Daily News.

According to new research, there were 40 breast cancer cases per 100,000 women among Alaska Natives from 1969 to 1973. That number increased to 138 cases per 100,000 women from 1994 to 1998, and then fell to 132 cases per 100,000 women from 1999 to 2004.

Janet Kelly, an epidemiologist with the Alaska Native Tribal Health Consortium, said that the findings might indicate that the increase is leveling off. However, she added, "I think you'd be hard-pressed to say there's anything (like a decline) going on yet."

A new report Kelly co-wrote with Anne Lanier, director of the consortium's research office, found that Alaska Native women's susceptibility to different types of cancer appears to vary by geographical region. The study looked at cancer in Alaska Natives from 1969 through 2003 and found that while breast cancer was the most prevalent type of cancer among Alaska Native women in Anchorage and the Interior, colorectal cancer was most prevalent among women in Barrow and coastal areas of western Alaska. The breast cancer rate in those areas was half the rate found in Anchorage.

Lanier said the small number of cancer cases in sparsely populated rural areas of Alaska makes it difficult to make statistically sound conclusions. She said, "This is a population that -- when I started working here 40-plus years ago -- we didn't even think cancer was a problem [in]," adding, "And what we have observed is a dramatic change ... particularly in lung cancer, but also in breast and prostate, which are also going up" (Bryson, Anchorage Daily News, 7/22).

source:http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53472

Breast Cancer: Breast Cancer in Men

Men Don't Have Breasts. How Can Men Get Breast Cancer?
Even though men do not have breasts like women, they do have a small amount of breast tissue. In fact the "breasts" of an adult man are similar to the breasts of a girl before puberty, and consist of a few ducts surrounded by breast and other tissue. In girls, this tissue grows and develops in response to female hormones, but in men -- who do not secrete the same amounts of these hormones -- this tissue does not develop.

However, because it is still breast tissue, men can develop breast cancer. In fact, men get the same types of breast cancers that women do, although cancers involving the milk producing and storing regions of the breast are very rare. According to the American Cancer Society, an estimated 1,690 cases of breast cancer will be diagnosed in men in 2005.

Why Do I Not Hear About Breast Cancer In Men As Much As I Hear About Breast Cancer In Women?
Breast cancer in men is a very rare disease. This is possibly due to their smaller amount of breast tissue and the fact that men produce smaller amounts of hormones like estrogen that are known to affect breast cancers in women.

In fact, only about 1 in 100 breast cancers affect men and only about 10 men in a million will develop breast cancer.

Which Men Are More Likely to Get Breast Cancer?
It is very rare for a man under age 35 to get breast cancer, but the likelihood of developing the disease increases with age, with most being detected between the ages of 60 - 70 years. Family history in a close female relative and a history of radiation exposure of the chest can also increase the risk.

The clearest risk for developing breast cancer seems to be in men who have had an abnormal enlargement of their breasts (called gynecomastia) in response to drug or hormone treatments, or even some infections and poisons. Individuals with a rare genetic disease called Klinefelter's syndrome, who often have gynecomastia as part of the syndrome, are especially prone to develop breast cancer. Men with severe liver disease tend to have lower levels of male hormones (androgens) and higher levels of female hormones (estrogens) putting them at an increased risk of developing gynecomastia and breast cancer.

How Serious Is Breast Cancer In Men?
Doctors used to think that breast cancer in men was a more severe disease than it was in women, but it now seems that for comparably advanced breast cancers, men and women have similar outcomes.

The major problem is that breast cancer in men is often diagnosed later than breast cancer in women. This may be because men are less likely to be suspicious of an abnormality in that area. In addition, their small amount of breast tissue is harder to feel -- making it more difficult to catch these cancers early, and allowing tumors to spread more quickly to the surrounding tissues.


source: http://www.webmd.com/breast-cancer/guide/breast-cancer-men

Breast Cancer Detection: A Simpler Alternative To Mammograms?

(Credit: Image courtesy of Medical College of Georgia)

Whether a painless, portable device that uses electrical current rather than X-ray to look for breast cancer could be an alternative to traditional mammograms is under study at the Medical College of Georgia.

MCG is one of 20 centers internationally and the only place in Georgia studying new technology developed by Z-Tech Inc., to compare traditional mammograms with impedence scanning, a technique based on evidence that electrical current passes through cancerous tissue differently than through normal tissue.

This phase of the study will focus on women age 40-50. Older women have less dense breast tissue so cancer is easier to find, says Dr. James Craft, MCG radiologist and principal investigator on the study. Mammograms, also performed in the study, are more accurate in this population, so this phase will be a tougher test of the new technology, he says. The first phase of the study, which began in 2005, was open to women of all ages.



“Normal breast tissue is very dense, especially in younger women, and can hide tumors,” Dr. Craft says. “While we’ve known for a while that water flows more freely through cancerous cells, we also know that electrical current flows easier through cancerous and tumor tissue.”

The Z-Tech scan works by placing a flower-shaped grouping of electrodes over each breast and sending a small, painless amount of electricity through them. Unlike traditional mammography, the scan does not involve breast compression or radiation.

“It’s like doing an EKG of the breast,” Dr. Craft says.

A computer immediately calculates and presents a report based on the electrical signature of the breast tissue. Rather than waiting on breast image from a traditional mammogram, the computer immediately notes whether the scan is positive or negative for cancer.

However, for study purposes, neither Dr. Craft nor the patient will know the results. Patients must undergo a mammogram within 90 days, which Dr. Craft interprets. Z-Tech compares those results to the electrical study.

The hope is that the new test – called HEDA for Homologous Electrical Difference Analysis – will provide an alternative to mammograms. While Dr. Craft believes that having this test should help find more cancers, he doesn’t think it will replace traditional mammography.

“This method doesn’t use radiation, is portable and there is no pain associated with the squeezing that mammograms require,” he says. “I can see it being used as an additional test. I don’t think it will replace mammography, but it could increase our chances of catching breast cancer.”

The second phase of the Z-Tech trial is open to women age 40-50 having routine mammograms as well as those who have a suspicious lump scheduled for biopsy.


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Adapted from materials provided by Medical College of Georgia.

source: http://www.sciencedaily.com/releases/2008/07/080722113019.htm

Mammograms a Pain? Gel Helps

Are you putting off getting a mammogram? It's easy for women to wince at the mere thought of getting screened for breast cancer.

A new study shows that a numbing gel eases pain associated with getting a mammogram and may make women more likely to return for subsequent screenings.

The study's lead author says in a news release that the numbing gel may act as a simple secret weapon: "We now have something that we know reduces discomfort with screening mammography in women who expect higher discomfort -- lidocaine gel."

Nurse practitioner Colleen Lambertz, with St. Luke's Mountain States Tumor Institute, says in a statement that reducing pain may mean more mammograms. "With a more positive experience, we hope women will undergo more regular mammography screening."

Painful Mammograms
Researchers gathered 418 women aged 32 to 89 years old.

All the participants had expected to have discomfort during a mammogram. In fact, 54 of the participants said they had "probably or definitely" delayed getting a mammogram because of the perceived discomfort associated with it.

The women were surveyed before the screening and after.
They were divided into three groups and given acetaminophen, ibuprofen, and/or the lidocaine gel before the mammogram. All of the medications were chosen because they are easy to get, over the counter, and have few side effects.

Less Pain After Mammogram Gel
Researchers found that those who received the numbing gel had "significantly" less breast discomfort.

Those who took the oral medications did not report significant easing of breast discomfort.

During a mammogram, the breasts are squeezed and pressed with a paddle so the X-ray can zone in to the dense tissue.

Women who expected to have a lot of discomfort during the mammogram did, as did women who had tender breasts.

Eighty-eight percent of the participants said they would "definitely" go back for a screening in the next year. Ten of the participants said they "probably" would go for their annual mammogram.

"Mammography is the only screening tool proven to reduce mortality from breast cancer in women over 40," according to prepared statements from study co-author James R. Maxwell, MD, medical director of St. Luke's Breast Care Services.

"Annual screening is the most important option available to a woman to best ensure early detection and decrease the chance of being diagnosed with an advanced stage breast cancer."

In background information published with the findings, study authors write that breast cancer accounts for "one-fifth of all deaths in women aged 40 to 50 years old."

The recent decrease in death rates from breast cancer is directly linked to better and increased screenings through mammograms.

The authors write, "Still, recent reports suggest that approximately one-half to two-thirds of women do not follow established guidelines for mammography."

As for the guidelines, the National Cancer Institute recommends that women get their first mammogram beginning at age 40 and every one to two years thereafter. Check with your doctor, as sometimes a screening mammogram is recommended before age 40 in women at higher than average risk.


source: http://www.webmd.com/breast-cancer/news/20080722/mammograms-a-pain-gel-helps

HEALTH TIPS: Weight, genes and breast cancer

For some women with a higher risk of getting breast cancer, getting weight down can be a way to fight back.

These women are in the minority with mutations in genes known as BRCA1 and BRCA2, which raise the risk of developing the cancer. The study, supported by the National Institutes of Health, found women with BRCA mutations decreased their higher risk of cancer if they lost at least ten pounds between the ages of 18 and 30.

Steven Narod of the University of Toronto, who was senior author of the paper in the journal Breast Cancer Research, says the findings ought to apply to overweight women who have the mutation:

“For women in that category, I certainly would discuss and raise with them the possibility that they could reduce the cancer risk through weight loss.”

Health Tip courtesy of the U.S. Department of Health and Human Services.

source: http://healthtipsatoz.com/health-tips-weight-genes-and-breast-cancer/