The Interface Between Family History, Genomics and Chemoprevention in Performing Breast Cancer Risk Assessment

1. The Interface Between Family History, Genomics and Chemoprevention in Performing Breast Cancer Risk Assessment Karen E. Lewis, MS, MM, CGC Priority Health Medical Policy and Technology Administrator

2. Identification of at-risk individuals and families What are you going to ask? If you don’t ask they may not tell Just because they tell does not make it true

3. MCC Breast risk assessment tool for Primary care providers has 3 questions to ask all women annually Do you have a personal history of breast/ovarian cancer? Do you have a family history of breast/ovarian cancer? Do you have a history of breast biopsy?

4. Personal History of Breast / ovarian Cancer ~1 in 7 women will develop breast cancer in their lifetime The younger the age at the time of diagnosis the more your interest should be peaked (<50 for breast CA) Verify the actual diagnosis (yes there are people who do not know what there specific diagnosis was) Refer to cancer genetics center for further evaluation

5. Family history of Breast / Ovarian CA Genetic predisposition mutations to breast / ovarian cancer are equal opportunity players You must ask about cancers on both the maternal and paternal sides of the family The more cancers on any one side of the family the more interesting the family becomes Age still counts but so do non-breast and non-ovarian cancers Refer to cancer genetics center for further evaluation

6. History of Breast Biopsy Personal history of atypical hyperplasia = refer for further evaluation and/or Gail model assessment Those with LCIS or increased risk associated with Gail model (>/= 1.7) should be referred for further discussion regarding chemoprevention and risk management strategies