FAMILY TIES

Risk test for breast cancer asks about ‘first-degree relatives’

Posted May 04, 2014, at 11:43 a.m.

What’s a first-degree relative, anyway? A woman doesn’t have to commit the answer to memory in order to use the Breast Cancer Risk Assessment Tool that the National Cancer Institute has placed online at cancer.gov/bcrisktool.

For purposes of the Breast Cancer Risk Assessment Tool, first-degree relatives include your mother, your sisters and your daughters. The question asks whether any of these relatives have had breast cancer.

The assessment also asks whether the you have the BRCA-1 gene or BRCA-2 gene, the presence of which could indicate a greater risk of breast cancer.

Other questions want to know when the woman had her first menstruation, and the age at which she had her first child. The risk assessment tool also wants to know the woman’s age.

I think it’s best, really, to take a look at the Breast Cancer Risk Assessment Tool before you “need” it, while you don’t have any real concerns about breast cancer in you or your family.

I didn’t think about risk assessment until I found a small lump just five weeks after a negative mammogram. First I went to my health care provider, who referred me for either a repeat mammogram or ultrasound.

After an ultrasound, the radiologist recommended a follow-up mammogram or other breast-imaging be done in three months to confirm that the area had not changed. According to the letter I received, the follow-up would be done on “an area that we believe is almost certainly benign [not cancer].” It is worded that way for legal reasons, I realize.

I’ve never been a fan, however, of the “wait and see if it changes” approach, and as it happens, my primary care provider isn’t either in this case. So I was referred to a breast surgeon who did another ultrasound, then showed me on the screen both regular cysts and the small nodule she expected was a cyst that had hardened.

We discussed options, and how I would be less concerned about the whole deal if she removed this first lump and found it a new home in a laboratory where it would be poked, prodded and properly identified.

I wasn’t really panicked about getting this breast lump checked out. My first-degree relatives have not had breast cancer at this point, and they do get regular mammograms.

There is, I believe, a cluster of breast cancer on my dad’s side of the family, namely his aunt and two cousins. The female ancestor I share with those women is my great-grandmother, Hattie (Moore) Moore, she being a first cousin of her husband, Alton Moore of Abbot. A geneticist friend was not concerned when I told him my great-grandparents were first cousins.

But I do wonder if their close relationship genetically had anything to do with Aunt Kay’s cancer. Allie and Hattie’s other children were male, including my grandfather Moore. So it’s obvious that those who had breast cancer were not first-degree relatives of mine.

Back to the Breast Cancer Risk Assessment Tool. I filled in all the answers, including my age, 62.

Presto chango, and the assessment has assigned me a risk of getting breast cancer in the next five years of 1.7 percent. That is below the risk for an average woman of 1.9 percent. In case I didn’t understand what 1.7 percent means, the assessment adds that my risk of not getting breast cancer in the next five years is 98.3 percent.

My lifetime risk of breast cancer, to age 90, is 7.7 percent. The lifetime risk for an average woman is 8.6 percent.

Being a bit of a showoff, I told the breast surgeon about my risks as calculated by the Breast Cancer Risk Assessment Tool.

My scores are for a woman who has never had a breast biopsy. Having had one though, even if it’s negative, will change my risk of getting breast cancer over the next five years from 1.7 to 2.0, just above the 1.9 percent for an average woman.

My lifetime risk of getting breast cancer, by virtue of having had a biopsy, would go from 7.7 to 9.0 percent, a little higher than the average woman’s risk at 8.6 percent.

Having the biopsy does not give a person cancer, as the surgeon emphasized. Rather, having a biopsy indicates that there was a concern about a person’s breast, and therefore, the expectation of getting breast cancer goes up a little.

Back to first-degree relatives. After specifying that the question concerns mother, sisters and daughters, the National Cancer Institute also recommends letting your health care provider know if any of your other first-degree relatives get breast cancer — your father or brothers or sons. While that’s not common, it does happen.

For women, menstruating at a later age, having a first child at a later age, or not having children at all can affect one’s risk for breast cancer.

So what is the biggest risk for breast cancer? Age. The older a woman is, the greater her risk.

My mother’s aunt was 81 when she was diagnosed with breast cancer, but it was not a factor in her death, as leukemia took her life less than a month later.

Cancer is not the disease that is most likely to take a woman’s life. Heart disease is the No. 1 killer.

For information on researching family history in Maine, see Genealogy Resources under Family Ties at bangordailynews.com/browse/family-ties. Send genealogy queries to Family Ties, Bangor Daily News, P.O. Box 1329, Bangor 04402, or email familyti@bangordailynews.com.

 

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