From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
In February 1999, Judy Garber, MD, discussed a 40-year-old woman whose
grandmother, mother, and sister had breast cancer.1
Both the woman's mother and sister died of the disease. Mrs T, the patient,
practiced breast self-examination and had yearly mammography starting at age
23 years. She was considering genetic testing and tamoxifen therapy. Dr Garber
discussed established risk factors for breast cancer, such as reproductive
factors, lifestyle factors, and family history. She explained that available
information on women's risk of breast cancer has limitations and that estimating
breast cancer risk for individual patients is challenging. Dr Garber detailed
the decision process for whether a patient should consider testing for the
presence of BRCA1 or BRCA2
genes. She also described medical management for patients with strong family
history of breast cancer, such as prophylactic mastectomy and tamoxifen.
Hartman EE, Parker RA. A 40-Year-Old Woman With a Strong Family History of Breast Cancer, 1 Year Later. JAMA. 2000;283(24):3243. doi:10.1001/jama.283.24.3243