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Detection and management of women at increased risk of breast cancer

Anthony Howell and Dafydd Gareth Evans

In this article we give a practioner’s perspective concerning the management of women at increased risk of breast cancer. Such women are usually identified because of a family history of breast cancer. However, there are a number of other risk factors including age of first pregnancy, age of menopause and use of hormone-replacement therapy that can be taken into account and incorporated with family history into predictive models. Prediction

is important because it determines management. For example, women with mutations in the BRCA1 and BRCA2 breast cancer genes have greater survival with appropriate screening and surgical and medical preventive measures. There is evidence to suggest that survival may also be improved with optimal management in the larger group of women without mutations but at

increased risk of breast cancer for other reasons.