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Clinical Crossroads Update
June 28, 2000

A 40-Year-Old Woman With a Strong Family History of Breast Cancer, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;283(24):3243. doi:10.1001/jama.283.24.3243

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.

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