Family History Updates Recommended in Breast Cancer Survivors

By Jill Stein

SAN ANTONIO DEC 11, 2008 (Reuters Health) - Researchers at the Moores Cancer Center at the University of California, San Diego Cancer Center are recommending that the cancer family history of breast cancer survivors be periodically updated.

The recommendation was made at the 2008 San Antonio Breast Cancer Symposium (2008) following a study that found that the prevalence of high-risk cancer family histories increased by 70% in a cohort of breast cancer survivors over a 7.5 year-follow-up period.

"Updating the family history has the potential to benefit patients and families who can undergo more aggressive surveillance or undertake risk reduction interventions," said Dr. Lisa Madlensky, assistant professor and research director at the Family Cancer Genetics Program.

The cancer family history is the most important tool in identifying women who may be at high risk of having hereditary breast-ovarian cancer syndrome (HBOCS) caused by mutations in the BRCA1 and BRCA2 genes, Dr. Madlensky pointed out. While many breast cancer patients may be asked about their family history at the time of their initial diagnosis, it is not known how many women initially classified as low risk for HBOCS become high risk over time as new cancers are diagnosed in their relatives, she added.

The UCSD group set out to determine how the prevalence of high-risk cancer family histories changes over time in breast cancer patients, and to determine how many breast cancer survivors at high risk for HBOCS self-report having undergone genetic testing for BRCA1/2.

Breast cancer survivors in the Women"s Healthy Eating and Living (WHEL) study provided detailed family history data -- on all first-degree relatives plus all grandparents, aunts and uncles -- at baseline and again at study closure. Patients were classified as high risk of HBOCS if the chance of having a mutation in either BRCA1 or BRCA2 was 10% or greater.

At baseline, 8.2% of 2508 survivors were classified as high risk. At follow-up an average of 7.5 years later, an additional 5.8% of women became high risk.

"The prevalence of a high-risk family history increased by 70% in our study cohort," Dr. Madlensky said. The increase was mainly due to new cancer diagnoses in relatives of women who were diagnosed with breast cancer before age 50.

The study also found that 15% of high-risk women had never heard of BRCA testing and that only 23% of women who would be appropriate candidates for BRCA testing had actually undergone such testing. Of those tested, 27% ended up having a mutation in BRCA1 or BRCA2.

As for how often clinicians should update the cancer family history of cancer survivors, Dr. Madlensky said that although this study did not aim to identify an optimal interval for updating, it is reasonable to ask all breast cancer survivors if there have been any new cancer diagnoses in their family on a yearly basis. She also noted that patients can be pro-active by informing their physicians of new cancers in the family when they occur, rather than waiting to be asked.

She added that her group is now working on ways to improve the collection of cancer family histories in oncology clinics and primary care settings, as well as studying ways to help families share and keep track of their cancer histories.


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