By Kari Danziger, MS, CGC

Reviewed by Beth Crawford, MS, CGC
Last updated August 25, 2000

Some women have a family history of breast or ovarian cancer, but not a history that is strong enough to indicate a defined hereditary syndrome. Their relatives may have developed cancer at a relatively old age, or perhaps there are whole generations without cancer in their families. Although these women, who are said to have a familial pattern of cancer, are less likely to develop breast or ovarian cancer than women who have inherited a mutation in any of the genes most strongly associated with these diseases, they are more likely to develop either disease than members of the general population. If you fall in to this category, your doctor will recommend that you follow aggressive screening guidelines.

Breast Cancer Screening

As with other cancers, if you discover a breast cancer in its early stages, you have a better chance of treating and halting the disease before it spreads to other parts of the body. Thus, the most important thing you can do to prevent breast cancer is to undergo vigalent screening. There are several procedures that you and your physician can use to screen for early signs of breast cancer.

Breast self-examination. By regularly examining your own breasts, you can detect any changes early on and bring them to the attention of your health care provider. Women between the ages of 20 and 40 may consider monthly breast self-exams. Women who are age 40, or within 10 years of the earliest breast or ovarian cancer onset in their family, are recommended to perform monthly breast self-exams. However, researchers have not yet conclusively proved that performing regular breast self-exams significantly reduces the risk of cancer.
Clinical breast examination. By examining a woman's breasts in a clinical setting, doctors can detect changes or suspicious masses that may be a sign of early-stage cancer. Women between the ages of 20 and 40 may consider clinical breast exams every three years. For women who are age 40, or within 10 years of the earliest breast or ovarian cancer onset in the family, clinical breast exams are recommended every 6 to 12 months.
Mammogram. By using low-level radiation X-rays, doctors are able to look for evidence of cancer in women who are not yet displaying any symptoms of the disease. For women with a familial history of breast cancer, doctors recommend annual mammograms beginning at age 40, or 10 years prior to the earliest breast cancer in the family.

Ovarian Cancer Screening

Women with a familial history of breast or ovarian cancer may also want to consider being screened for ovarian cancer. However, these recommendations are still subject to debate because the currently available methods of screening for the disease are less than perfect. Sometimes they fail to detect cancer when it's present, and other times they falsely identify noncancerous conditions, including pregnancy, endometriosis and benign ovarian masses as cancer. These errors can cause unnecessary anxiety for patients and require expensive and unpleasant follow-up (such as biopsies) to clarify the results.

The most common form of ovarian cancer screening is the pelvic exam that women receive during their annual check up. Although the pelvic exam can occasionally detect ovarian cancer, it often misses cancers or only detects a cancer when it is quite advanced and harder to treat. Despite their limitations in detecting ovarian cancer, pelvic exams are an important part of a woman's annual check up because they allow the doctor to screen for cervical cancer.

In addition to pelvic exams, doctors currently use two procedures to screen for ovarian cancer. Before you seriously consider either screening method, you should talk to your doctor to determine whether they are appropriate for you.

Transvaginal ultrasound with color doppler. In this procedure, a doctor inserts a small monitor through a woman's vagina and then uses ultrasound, or sound waves, to view the ovaries on a computer screen. The addition of color doppler allows the doctor to see detail about blood flow in the tissue, which helps detect abnormalities that can indicate ovarian cancer.
CA-125 testing. This test measures the level of the chemical CA-125, which is known as a tumor marker, in an individual's bloodstream. Because ovarian cancers usually produce this chemical, an above-average amount of CA-125 can indicate ovarian cancer. The test is most accurate for postmenopausal women.

Resources

American Cancer Society Breast Cancer Resource Center
(including information on how to perform a breast self-examination)

References

Daly, M. et al. (1999). NCCN practice guidelines: genetics/familial high-risk cancer screening. Oncology. 13:161-183

US Preventative Services Task Force. (1996). Guide to clinical preventive services. (2nd ed.) Alexandria, VA: International Medical Publishing.

NIH Consensus Conference. (1995). Ovarian cancer. Screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. JAMA. 273(6):491-7.

Andolf, E. et al. (1990) Ultrasound examination for detection of ovarian carcinoma in risk groups. Obstet Gynecol. 75(1):106-109.