breast cancer and family history ksa 2018

FAMILY HISTORY

&

BREAST CANCER

DR. MOHAMAD AL-GAILANI FRCS

CONSULTANT BREAST SURGEON

MEDICAL EDUCATION & TRAINING HEAD

OCTOBER BREAST CANCER AWARENESS MONTH2017

Riyadh, KSA

OUTLINE:

FAMILY HISTORY & BREAST CANCER (BC)

A QUESTION & ANSWER SESSION

• Q1: How can I reduce my risk of developing BC?

• Q2: Are all breast cancers familial?

• Q3: How can I determine if my family history of BC is significant?

• Q4: Having a significant family history of BC, can I do something

about it?

• Q5: Does the Oral Contraceptive Pill (OCP) increase BC Risk?

• Q6: Does Hormone Replacement Therapy (HRT) increase BC Risk?

OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA

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BREAST CANCER

• Breast cancer (BC) is the most common cancer among

women

•Accounting for about 22% of all female cancers.

• It is expected to affect 1:8 (12%) of women during

their lifetime.

• In KSA, it affects a younger age group, on average a

decade younger than in the West.

• In KSA, 16% Breast Screening Uptake (MOH 2016)


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THE REALITY OF INCURABLE BREAST CANCER

RISK FACTORS

• REPRODUCTIVE RISK FACTORS

• Early Menarche <12

• Late Menopause >55

• Nullipara

• Age first birth >30

• None Breast Feeding

• NON REPRODUCTIVE RISK

FACTORS

• Age

• Family History

• Obesity

• Alcohol

• HRT >10 years


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Q1: HOW CAN I REDUCE MY RISK OF

DEVELOPING BC?

• There are lifestyle choices that can reduce the risk of breast

cancer:

1. Early First Child <30, Breast Feed >1 year, Multiparity

2. Maintain ideal body weight (obesity is a risk factor)

2. Exercise regularly

3. Avoid alcohol

4. Eat nutritious food

5. Avoid smoking OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA

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Q2: ARE ALL BREAST CANCERS

FAMILIAL?

• NO

• Nearly 90% of BC are incidental, (bad luck!)

• However10% could be familial.

• The risk of BC increases, the higher the number of relatives

who have been diagnosed with breast cancer.

• Especially if they are first degree relatives (Mother, Sister,

Daughter)

• Diagnosed at a younger age <40 years.OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA

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BRCA1 & BRCA2 GENE MUTATION

• Inherited Breast Cancer genes BRACA1 & BRACA2

• 80% BC Lifetime Risk

• 50% Ovarian Cancer Lifetime Risk.

• Significantly High Family History of Breast and Ovarian

Cancers.

•Genetic blood tests Diagnostic.OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA

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Q3: HOW CAN I DETERMINE IF MY FAMILY

HISTORY OF BC IS SIGNIFICANT?

• Through Breast Cancer Family History Assessment

• Low: (Population Average) Lifetime Risk 12%

•Moderate: Lifetime Risk 17-30%

•High: Lifetime Risk >30%

• BRCA Probability >30%


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CASE 1

• AGE 30• 2 RELATIVES BC:1. M. GM 602. P. AUNT 65

• BREAST CANCER RISK ASSESSMENT:

• 10 YEAR RISK 1.2%• LIFETIME RISK 28.5%• PROB. BRCA 0.14-

0.16%• RESULT:

• MODERATE

• ADVICE:

• Annual

Mammograpy Age

40-50

BREAST CANCER FAMILY HISTORY RISK ASSESSMENT


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CASE 2

• AGE 40• 4 RELATIVES: 1. SISTER 39 2. SISTER (Ov) 35 3. MOTHER 35 4. M. GM 55

• BREAST CANCER RISK ASSESSMENT:

• 10 YEAR RISK 58%• LEFETIME RISK 91.3• PROB. BRCA1 GENE 41.1%• RESULT:

• HIGH

• ADVICE:

• Gene Testing To

Exclude BRCA Gene

Mutation

BREAST CANCER FAMILY HISTORY RISK ASSESSMENT

Q4: HAVING A SIGNIFICANT FAMILY

HISTORY OF BC, CAN I DO SOMETHING

ABOUT IT?

Yes

1.Breast Surveillance: Breast screening, Breast Self Exam (BSE) & Clinical Breast Exam (CBE)

2.Chemoprevention

3.Risk Reducing Mastectomy with Immediate Reconstruction


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BREAST SURVEILLANCE

• Breast Screening plan tailored to the risk.

1. BSE: Monthly

2. CBE: Annual

3. Mammography: Annual from age 40

4. Magnetic Resonance Imaging (MRI) BRCA carriers:

Annual from Age 30


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THE BREAST CANCER SCREENING PROGRAMME


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CHEMOPREVENTION

• Women diagnosed with BRCA gene or with a significant high

family history benefit from Chemoprevention.

• 40% Risk Reduction.

• SERMS (Selective Oestrogen Receptor Modulator):

• Tamoxifen (Nolvadix)

• Raloxifene (Evista)


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TAMOXIFEN * RALOXEFINE

• Given for 5 years only

• Any age group Pre and Post Menopausal

• Precautions:

• Deep Vein Thrombosis (DVT) X

• History of Endometrial Cancer X

• Pregnancy X

* * NICE Clinical Guideline, March 2017


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RISK REDUCING MASTECTOMY (RRM) & IMMEDIATE BREAST RECONSTRUCTION

• Risk reduction up to 90%

• Much higher than any Chemoprevention (40%)

• Recommended for women with BRCA1 or BRCA2 carriers

or with significant family history

• Prophylactic Laparoscopic Oophorectomy up to 50% lifetime

risk of Ovarian Cancer (BRCA gene carriers)

• Requires psychological counsellingOCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA

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Q5: DOES THE ORAL CONTRACEPTIVE PILL

(OCP) INCREASE BC RISK?

•Under the age of 35: No significant risk

•Over the age of 35: there is a risk that taking

OCP might increase their risk of BC

•Alternative methods of contraception are advised


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Q6: DOES HORMONE REPLACEMENT

THERAPY (HRT) INCREASE BC RISK?

• There is a risk involved in taking HRT

• The benefits should be weighed against the risk

•Oestrogen-Only HRT is recommended

• Shortest duration of time: usually 5 years

• Risk becomes significant on usage beyond 10 years.


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WHAT IS BEST FOR ME?

• Every woman’s BC risk is different from others.

• Based on her assessed risk, the appropriate measures could be

advised.

• It is important to remember that any action, not even removing

both breasts completely eliminates the risk.

• Continued close monitoring remains necessary, even after Risk

Reducing Mastectomy.


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CONCLUSION

•Only 10% of BC are Familial

• Risk reduction options are tailored towards the

individual’s risk

• Breast Screening, Breast Self Exam and Annual Breast

Clinical Exam help with Earlier Diagnosis, but do not

reduce Risk!

• Risk Reducing Chemoprevention: up to 40% Risk

Reduction

• Risk Reducing Mastectomy: 90% Risk Reduction


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breast cancer and family history ksa 2018

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