How Family History and Your Unique Situation Affect Treatment Options

Having a family history of breast cancer can affect how DCIS is treated. A strong family history of breast cancer can mean a higher risk for developing another breast cancer in the future.

A family history of breast cancer can come from the mother's side or the father's. But some family histories are significant and others aren't. A strong and significant family history means that a number of people in your family have had breast cancer and possibly also ovarian cancer. And it's especially true if the diagnosis of cancer was made before the age of 50.

If you have a strong family history of breast cancer, genetic counseling might be very helpful. After a careful review of your family history, your doctor may suggest testing for abnormalities in the breast cancer genes BRCA1 or BRCA2.

The function of these genes is to keep breast cells growing normally and to prevent any cancer cell growth. But when these genes contain abnormalities, or mutations, they are associated with an increased breast cancer risk. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers.

Having DCIS raises your risk for developing an invasive cancer later on. So, it is particularly important to learn the details of your health history and that of your mother, sister, and daughter as well as your father's close female relatives. This will help you decide whether to be tested for genetic abnormalities. It will also help you find out how your genetic picture might weigh into your treatment decisions.

For example, if you have the gene abnormality, you may choose to be followed carefully over time with a number of breast imaging studies. Or you may choose to be more aggressive and take risk-lowering medications — and possibly even have preventive or prophylactic surgeries.

Your personal situation will also affect the decisions you make about treatment.

Do you have access to a radiation oncology center?

The hospital where you had your surgery may have its own radiation oncology department. Whether it does or does not, your surgeon can refer you to a radiation oncology doctor with whom he or she works on a regular basis.

Getting radiation requires many visits to the treatment facility. With whole breast radiation, you need to be at the center five days a week for six to seven weeks. (The treatment itself takes up a small part of each day.) When you choose a radiation oncology center, you'll either need to live close to that center, or travel to that area and stay for a few weeks.

With the new technique of partial breast radiation, radiation is given twice a day for five days total (one week).

Do you have access to a plastic surgeon for reconstruction?

If you have a mastectomy, you may choose to have reconstruction of the breast. The doctor who does the reconstruction is called a plastic surgeon. And it's important to select a plastic surgeon who has expertise and experience in reconstructive breast surgery. Ask your doctor and cancer surgeon to recommend reconstructive surgeons in your area. Also ask other women who have had reconstruction. Many will be willing to show you their results.

It is always a good idea to interview several people before you make your decisions. Some of those decisions include:

• Will you have reconstruction or not (many women do, plenty of women don't)?
• If you want reconstruction, which breast surgeon will you use?
• Will you have the reconstruction during the surgery for your mastectomy or later? If it's during the original surgery, the plastic surgeon has to be able to work as a team with your cancer surgeon in the same operating room.

Most women who have lumpectomy do not have any reconstruction. However, if you have had several lumpectomies in the same breast, the shape and size of that breast can be very different from the other breast. Some women in this situation may want to consider reconstructive surgery.

Be sure you ask the surgeons to see photographs of a full range of results. This will help you to understand the possibilities for what your own situation might be.

What is your style of making decisions?

Each one of us makes decisions in our own way. For example

• You may "go with your gut" and act because you just feel it's right.
• You may research things thoroughly and only do what's completely rational.
• You may ask your friends, relatives, and loved ones what they think, and then decide.
• You may keep things to yourself and prefer to make the choice on your own after talking with your doctor.

You decide what's best for you. And because dealing with DCIS from diagnosis through recovery can be a long process, there are a lot of decisions along the way.

Review and discuss all the information from your personal situation and history, mammograms and any other imaging tests, and pathology report carefully with your doctors. Solid advice from your doctors can give you the confidence and knowledge you need to make the best decisions for you.