Cancer Risk AssessmentBreast and Ovarian Cancer家族性癌症的风险assessmentbreast和卵巢癌课件.ppt

* * * Gail Model: 5 year risk of 1.1%; lifetime risk of 18.8% Claus Model: Lifetime risk of 18.8% based on mother, age 58 and maternal aunt, age 65 Myriad table – risk of BRCA1/2 mutation: 2.9% risk of mutation based on family history (no one with breast 50 or ovarian cancer) Pedigree analysis: no indications of other breast cancer syndromes * * * Again, it is important for patient to check own insurance policy to see if genetics referral is covered. Some patients will not want their insurance notified of a genetics referral because of concerns about insurance discrimination. Consider cancer genetic counseling referral if: Myriad table indicates significant risk for BRCA1/2 mutation Family medical history is suspicious for a hereditary cancer syndrome Client has extreme anxiety about the cancer family history Client has questions beyond the scope of your practice “High/Genetic Risk” Indications for referral Two 1st degree, or one 1st and one 2nd degree relative in the same lineage with breast cancer 50 yrs 3 or more family members (1st or 2nd degree) with breast cancer, same lineage, any age Male with breast CA + breast or ovarian CA in a relative “High/Genetic Risk” Indications for referral (cont.) Patient or 1st degree relative with breast CA 40 yrs, with or without family history Two or more cases of ovarian CA, same lineage Ashkenazi Jewish ancestry and any family history of breast 50 or ovarian cancer, any age Both breast and ovarian CA, same lineage Case 2: Alison Alison is a 40 year old Caucasian (non-Jewish) patient who asks you for information about the “breast cancer gene test”. She states she wants this test. You ask her about her family history: Mother with breast cancer - age 58 Maternal aunt with breast cancer – age 65 Paternal grandmother with breast cancer – age 79 Alison has no other risk factors for breast cancer. Menses began at age 11. 1st child at age 25. She feels that with her family history, breast cancer is inev