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June 13, 2001

Genetic Susceptibility to Breast CancerFrom the Roll of the Dice to the Hand Women Were Dealt

Author Affiliations

Author Affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.

JAMA. 2001;285(22):2907-2909. doi:10.1001/jama.285.22.2907

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.

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