Skill Checkup: A 56-Year-Old Woman With a History of Breast Cancer and Pain in Her Ribs and Spine

About 5%-10% of breast cancers are hereditary, and the most common cause of hereditary breast cancer is a BRCA1 or BRCA2 mutation (only rarely do the mutations coexist in the same person). A patient who carries a BRCA1 or BRCA2 gene mutation has a significantly increased risk of developing breast cancer. Moreover, BRCA1 and BRCA2 mutations cause approximately 20%-25% of hereditary breast cancers, respectively, and 5%-10% of all breast cancers. These risk ratios increase in carriers aged 70 years or older as well.

Some women with a BRCA1/BRCA2 mutation opt to have a prophylactic double mastectomy. Because the current patient did not have a BRCA mutation, she chose not to have a double mastectomy. When a BRCA mutation is present, such extensive surgery can reduce the risk of developing breast cancer by at least 90%. Other approaches include:

• Taking medications, such as tamoxifen, raloxifene, and aromatase inhibitors, to lower the risk of developing breast cancer. However, these agents can have significant side effects, including blood clots, endometrial cancer, and dyslipidemia.

• Annual screening with breast MRI and mammography, possibly starting at a younger age

• Genetic counseling — widely considered mandatory

• Colon and ovarian cancer evaluation — highly recommended

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Cite this: Pavani Chalasani. Skill Checkup: A 56-Year-Old Woman With a History of Breast Cancer and Pain in Her Ribs and Spine - Medscape - Jan 14, 2022.