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Carrie C. Morrison, MD, St. Luke's Hospital

The genetic link to breast cancer

There are several gene mutations that increase a woman's risk of getting breast cancer. The most common and most widely researched of these are BRCA1 and BRCA2. They are responsible for only five to ten percent of all breast cancers, but having one of these genes dramatically increases your risk.

On average, one out of every eight women will develop breast cancer. Having BRCA1 increases the likelihood of developing breast cancer up to 85 percent, and having BRCA2, up to 65 percent.

How do you know if you have one of these genes? Patterns of cancer-not just breast cancer-in your family history are the best indicators. Red flags include having a female relative with breast cancer at an early age, a male relative with breast cancer, a family member with breast cancer in both breasts, a female relative with ovarian cancer, a second cancer in a relative with breast cancer and family members with other cancers-particularly ovarian, prostate and pancreatic cancers and melanoma, a type of skin cancer. If any of these patterns are in your family, you might want to consider gene testing.

Testing for BRCA1 and 2 involves a simple blood draw, yet the test can cost a few thousand dollars, and it is not covered by all insurance plans. If the test reveals that you have one of the genes, you may need to get mammograms or breast MRIs more often. Your physician will need to monitor you more closely. Preventative options include medications like tamoxifen and raloxifene. Also, preventative bilateral mastectomy (surgical removal of both breasts) and preventative removal of the ovaries may be considered.

Every woman is at risk for breast cancer, and it is important to remember that most breast cancers are not hereditary. Even if you have no family history of breast cancer, you still need to get the recommended screenings. Women at average risk of developing breast cancer should get annual clinical breast examinations and do monthly self-examinations starting in their early 20's. Yearly mammograms should begin by age 40.

Make sure to update your family history at every doctor's visit. This information could help save your life.

Carrie C. Morrison, MD, is the director of breast imaging and mammography at St. Luke's Hospital. Call 314-205-6491 or visit her Physician Referral page.

This article was published in the St. Louis Post-Dispatch on October 8, 2009.

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