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February 19, 1997

Genetic Polymorphisms and Breast Cancer Risk-Reply

Author Affiliations

National Center for Toxicological Research Jefferson, Ark
State University of New York at Buffalo
National Cancer Institute Bethesda, Md

JAMA. 1997;277(7):534. doi:10.1001/jama.1997.03540310032029

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In Reply.  —We appreciate the comments of Dr Kazandjian. One cannot argue against anything that would promote better training of medical students and consequently alter the "destiny" of their patients through better management and education. However, we would emphasize that disease susceptibility based on carcinogen metabolism may confer no risk without exposure to that compound. Specifically, for most cancers, while the carcinogen-metabolizing genes are predisposing, they are not predetermining, and one's destiny (ie, genetic risk) can be altered by behavior modification. It also is important to understand that NAT2 is only one of many genes involved in cancer susceptibility. Thus, risk from this gene and tobacco smoke exposure may be only 1 pathway in breast carcinogenesis with several other intervening variables.Kazandjian also raises the issue that the knowledge of a patient's predisposition for the physician would empower him or her to advise the patient on lifestyle choices that may reduce the