Clinical Crossroads
November 24, 1999

A 40-Year-Old Woman With a Strong Family History of Breast Cancer

Author Affiliations

Author Affiliation: Dr Garber is Director, Cancer Risk and Prevention, Department of Adult Oncology, Dana-Farber Cancer Institute and Assistant Professor of Medicine, Harvard Medical School, Boston, Mass.


Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

JAMA. 1999;282(20):1953-1960. doi:10.1001/jama.282.20.1953

DR DALEY: Mrs T is a 40-year-old married mother of 3 children with a strong family history of breast cancer who is considering genetic testing and tamoxifen therapy. She lives on Cape Cod, Mass, and works at home caring for her 3 children, ages 7, 5, and 2. Her health insurance is provided through a managed care plan.

Mrs T is in good health. She is of Dutch and English ancestry. Her maternal grandmother was diagnosed with breast cancer in her seventh decade and was treated with surgery. She died of causes unrelated to breast cancer. Mrs T's mother developed breast cancer and died of complications related to breast cancer metastatic to bone. Her sister developed breast cancer at age 26 and died at age 38 of complications related to metastatic breast cancer to lymphatics and lung. Mrs T has had yearly mammography since age 23 and semiannual breast examinations. She practices breast self-examination. Mrs T has decided not to have genetic testing because she is aware that negative test results do not assure her that she will not develop breast cancer. She says that having a prophylactic mastectomy would be a "big" decision. After several months of consideration, she recently began a course of tamoxifen and has not experienced any noticeable adverse effects. She is ambivalent about genetic testing, wants to know what the future of "gene therapy" is, and is curious about what the future holds for her 2-year-old daughter.

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