Author Affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
In 1866, French physician Paul Broca reported 10 cases of breast cancer
in 4 generations of his wife's family.1 Despite
the potential of this historic observation, the next 120 years brought more
frustration than progress in the assessment of breast cancer risk. The increasing
appreciation of the complex and multifactorial etiology of breast cancer,
the inability to identify modifiable breast cancer risk factors, the lack
of effective breast cancer prevention, and the national focus on population-based
breast cancer screening all contributed to the pervasive "half-empty" view
of breast cancer risk prediction. A 1991 internal medicine textbook introduced
the section on breast cancer risk with the statement "an inappropriate emphasis
on risk factors may obscure the fact that 70 to 80 percent of all breast cancers
occur in patients without identifiable risk factors."2
For patients and physicians alike, breast cancer risk was seen as a roll of
the dice, a random event beyond their control.
Armstrong K. Genetic Susceptibility to Breast CancerFrom the Roll of the Dice to the Hand Women Were Dealt. JAMA. 2001;285(22):2907-2909. doi:10.1001/jama.285.22.2907