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.
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.
Garber J. A 40-Year-Old Woman With a Strong Family History of Breast Cancer. JAMA. 1999;282(20):1953-1960. doi:10.1001/jama.282.20.1953