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Management of familial breast cancer risk

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Abstract

Women who are members of breast cancer families are at increased risk for breast cancer. The cloning of BRCA1 and BRCA2 has made it possible to identify mutation carriers within some of these families. Management of breast cancer risk in these families, which presents enormous challenges to patients and clinicians, is addressed. Management should begin with a full evaluation of the patient, including construction of a three-generation pedigree, ascertainment of non-genetic factors that may impact on risk, information on previous and current breast health, practice of and attitudes toward screening, and the psychosocial impact of family history on the individual. Patient priorities in risk management should be explicitly reviewed; these may include survival, cancer prevention, breast preservation, optimization of quality of life or minimization of disruption of day-to-day activities. Approaches to risk management involve screening (usually considered the mainstay), anti-estrogens, prophylactic surgery and/or lifestyle modifications. Specific gene therapy may become available in the future. Management decisions should be individualized to reflect risk levels and patient priorities and goals, within bounds that are medically and scientifically reasonable. An explicit examination of different time-frames (1, 5, 10 years) is recommended given the rapid evolution of knowledge in this area.

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References

  1. Offit K: Breast cancer syndromes. In: Clinical Cancer Genetics: Risk Counseling and Management, Wiley-Liss, New York, NY, 1998, pp 66–115

    Google Scholar 

  2. Miki Y, Swensen J, Shattuck-Eiders D, et al.: A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 226: 66–71, 1994

    Google Scholar 

  3. Wooster P, Biguell G, Lancaster J, et al.: Identification of the breast cancer susceptibility gene BRCA2. Nature 378: 789–792, 1995

    Google Scholar 

  4. Berry DA, Parmigiani G, Sanchez J, et al.: Probability of carrying a mutation of breast-ovarian cancer gene BRCA1 based on family history. J Natl Cancer Inst 89: 227–238, 1997

    Google Scholar 

  5. Couch FJ, DeShano M, Blackwood MA, et al.: BRCA1 mutations in women attending clinics that evaluate the risk of breast cancer. New Engl J Med 336: 1409–1415, 1997

    Google Scholar 

  6. Szabo CI, King M-C: Population genetics of BRCA1 and BRCA2. Am J Hum Genet 60: 1013–1020, 1997

    Google Scholar 

  7. Weber BL: Update on breast cancer susceptibility genes. In: Perry MC (ed) American Society of Clinical Oncology. Alexandria, VA, 1998, pp 242–248

  8. Ford D, Easton DF, Bishop DT, et al.: Risks of cancer in BRCA1 mutation carriers. Lancet 343: 692–695, 1994

    Google Scholar 

  9. Easton DF, Bishop DT, Ford D, et al.: Genetic linkage analysis in familial breast and ovarian cancer: results from 214 families. Am J Hum Genet 52: 678–701, 1993

    Google Scholar 

  10. Struewing JP, Hartge P, Wacholder S, et al.: The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. New Engl J Med 336: 1401–1408, 1997

    Google Scholar 

  11. Thoralacius S, Struewing JP, Hartge P, et al.: Populationbased study of risk of breast cancer in carriers of BRCA2 mutation. Lancet 352: 1337–1339, 1998

    Google Scholar 

  12. Ford D, Easton DF, Stratton M, et al.: Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. Am J Human Genet 62: 676–689, 1998

    Google Scholar 

  13. Ford D, Easton DF, Bishop DT: Breast and ovarian cancer incidence in BRCA1 mutation carriers. Am J Hum Genet 56: 265–271, 1995

    Google Scholar 

  14. Warner E, Foulkes W, Goodwin PJ, et al.: Prevalence and penetrance of BRCA1 and BRCA2 mutations in unselected Ashkenazi Jewish women with breast cancer. J Natl Cancer Inst 91: 1241–1247, 1999

    Google Scholar 

  15. Andrain J, Rimer B, Cella D, et al.: Genetic counselling and testing for breast-ovarian cancer susceptibility: What do women want? J Clin Oncol 16: 133–138, 1998

    Google Scholar 

  16. Goodwin PJ: Genetic testing for breast cancer predisposition–a Pandora's box? J Soc Ob Gynecol Can 21: 787–794, 1999

    Google Scholar 

  17. Miller AB, Baines CJ, To T, et al.: Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women age 40–49 years. Can Med Assoc J 147: 1459–1476, 1992

    Google Scholar 

  18. Miller AB, Baines CJ, To T, et al.: Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J 147: 1477–1488, 1992

    Google Scholar 

  19. Alexander FE, Anderson TJ, Brown HK, et al.: The Edinburgh randomized trial of breast cancer screening: results after 10 years of follow-up. Br J Canc 70: 542–548, 1994

    Google Scholar 

  20. Shapiro S, Vanet W, Strax P, et al.: Ten-to-fourteen year effect of screening on breast cancer mortality. J Natl Cancer Inst 69: 349–356, 1982

    Google Scholar 

  21. Tabar L, Fagerberg G, Chen HH, et al.: Efficacy of breast cancer screening by age: new results from the Swedish two-county trial. Cancer 75: 2507–2517, 1995

    Google Scholar 

  22. Frisell J, Eklund G, Hellstrom L, et al.: Randomized study of mammographic screening – preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat 18: 49–56, 1991

    Google Scholar 

  23. Anderson I, Aspergren K, Janzon L, et al.: Mammographic screening and mortality from breast cancer: the Melmö mammographic screening trial. Br Med J 297: 943–948, 1988

    Google Scholar 

  24. Bjurstam N, Björneld L, Duffy SW, et al.: The Gothenburg breast cancer screening trial: preliminary results on breast cancer mortality for women aged 39–49. J Natl Cancer Inst Monogr 22: 53–55, 1997

    Google Scholar 

  25. Baines CJ, Miller AB, Bassett AA: Physical examination. Its role as a single screening modality in the Canadian National Breast Screening Study. Cancer 63: 1816–1822, 1989

    Google Scholar 

  26. Baines CJ, Miller AB: Mammography versus clinical examination of the breasts. J Natl Cancer Inst Monogr 22: 125–129, 1997

    Google Scholar 

  27. Kerlikowske K, Grady D, Rubin SM, et al.: Efficacy of screening mammography: a meta-analysis. JAMA 273: 149–154, 1995

    Google Scholar 

  28. National Institutes of Health Consensus Development Conference Statement: Breast cancer screening for women ages 40–49, January 21–23, 1997. J Natl Cancer Inst 89: 1015–1026, 1997

    Google Scholar 

  29. Statement from the National Cancer Institute on the National Cancer Advisory Board Recommendations on Mammography. National Institutes of Health. Office of Cancer Communications. March 27, 1997

  30. Hendrich RE, Smith RA, Rutledge JH, et al.: Benefit of screening mammography in women aged 40–49: A new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 22: 87–92, 1997

    Google Scholar 

  31. Berry DA: Benefits and risks of screening mammography for women in their forties: a statistical appraisal. J Natl Cancer Inst 90: 1431–1439, 1998

    Google Scholar 

  32. Kerlikowske K, Grady D, Barclay J, et al.: Positive predictive value of screening mammography by age and family history of breast cancer. JAMA 270: 2444–2450, 1993

    Google Scholar 

  33. Lalloo F, Boggis CRM, Evans DGR, et al.: Screening by mammography, women with a family history of breast cancer. Eur J Cancer 34: 937–940, 1998

    Google Scholar 

  34. Kollias J, Sibbering DM, Blamey RW, et al.: Screening women aged less than 50 years with a family history of breast cancer. Eur J Cancer 34: 878–883, 1998

    Google Scholar 

  35. Kerlikowske K, Grady D, Barclay J, et al.: Effect of age, breast density and family history on the sensitivity of first-screening mammography. JAMA 276: 33–38, 1996

    Google Scholar 

  36. Helvie MA, Robidoux MA, Weber BL, Merajver SD: Mammography of breast carcinoma in women who have mutations of the breast cancer gene BRCA1: Initial experience. AJR 168: 1599–1602, 1997

    Google Scholar 

  37. Nelson NJ: BRCA2 research is on a fast track to the clinic. J Natl Cancer Inst 90: 1502–1503, 1998

    Google Scholar 

  38. Nelson NJ: Finding BRCA1's function: a more arduous journey. J Natl Cancer Inst 90: 1503, 1998

    Google Scholar 

  39. Sharan SK, Morimatsu M, Albrecht U, et al.: Embryonic lethality and radiation hypersensitivity mediated by Rad51 in mice lacking BRCA2. Nature 386: 804–810, 1997

    Google Scholar 

  40. Abbott DW, Freeman ML, Holt JT: Double-strand break repair deficiency and radiation sensitivity in BRCA2 mutant cancer. J Natl Cancer Inst 90: 978–985, 1998

    Google Scholar 

  41. Chabner E, Nixon A, Gelman R, et al.: Family history and treatment outcome in young women after breast-conserving surgery and radiation therapy for early-stage breast cancer. J Clin Oncol 16: 2045–2051, 1998

    Google Scholar 

  42. Feig SA, Jaffe MJ: Current status of digital mammography. Semin Ultrasound, CT and MRI 17: 424–443, 1996

    Google Scholar 

  43. Williams MB, Pisano ED, Schuall MD, et al.: Future directions in imaging of breast diseases. Radiology 206: 297–300, 1996

    Google Scholar 

  44. Staren ED, O'Neill TP: Breast ultrasound. Surg Clin North America 78: 219–235, 1998

    Google Scholar 

  45. Harms SE: Breast magnetic resonance imaging. Semin Ultrasound, CT and MRI 19: 104–120, 1998

    Google Scholar 

  46. Baines, CJ: Breast self-examination. Cancer 69: 1942–1946, 1992

    Google Scholar 

  47. Thomas DB, Gao DL, Self DG, et al.: Randomized trial of breast self-examination in Shanghai: Methodology and preliminary results. J Natl Cancer Inst 89: 355–365, 1997

    Google Scholar 

  48. Semiglazov VF, Moiseenko VM, Protsenko SA, et al.: Preliminary results of the Russia (St. Petersberg/WHO program for the evaluation of the effectiveness of breast selfexamination. Voprosy Onkologii 42: 49–55, 1996

    Google Scholar 

  49. UK Trial of Early Detection of Breast Cancer Group: First results on mortality reduction in the UK trial of early detection of breast cancer. Lancet ii: 411–416, 1998

    Google Scholar 

  50. Holmberg L, Ekbom A, Calle E, et al.: Breast cancer mortality in relation to self-reported use of breast self-examination. A cohort study of 450,000 women. Breast Cancer Res Treat 43: 137–140, 1997

    Google Scholar 

  51. Gastrin G, Miller AB, To T, et al.: Incidence and mortality from breast cancer in the Mama Program for breast screening in Finland, 1973–1986. Cancer 73: 2168–2174, 1994

    Google Scholar 

  52. Harvey BJ, Miller AB, Baines CJ, et al.: Effect of breast self-examination techniques on the risk of death from breast cancer. Can Med Assoc J 157: 1205–1212, 1997

    Google Scholar 

  53. Kurebayashi J, Shinozuma K, Sonoo H: The practice of breast self-examination results in the earlier detection and better clinical course of Japanese women with breast cancer. Jpn J Surg 24: 337–341, 1994

    Google Scholar 

  54. Mant D, Vessey MP, Neil A, et al.: Breast self-examination and breast cancer stage at diagnosis. Br J Cancer 55: 207–211, 1987

    Google Scholar 

  55. Ogawa H, Tominaga S, Yoshida M, et al.: Breast selfexamination practice and clinical stage of breast cancer. Jpn J Cancer Res 78: 447–452, 1987

    Google Scholar 

  56. Ota J, Horino T, Taguchi T, et al.: Mass screening for breast cancer: Comparison of the clinical stages and prognosis of breast cancer detected by mass screening and in out-patient clinics. Jpn J Cancer Res 80: 1028–1034, 1989

    Google Scholar 

  57. Locker AP, Caseldine J, Mitchell AK, et al.: Results from a seven-year programme of breast self-examination in 89,010 women. Br J Cancer 60: 401–405, 1989

    Google Scholar 

  58. Huguley CM, Brown RL, Greenberg RS, et al.: Breast selfexamination and survival from breast cancer. Cancer 62: 1389–1396, 1988

    Google Scholar 

  59. Auvenin A, Eloviainio L, Hakawa M: Breast self-examination and survival from breast cancer: a prospective follow-up study. Br Cancer Res Treat 38: 161–168, 1996

    Google Scholar 

  60. Le Geyte M, Mant D, Vessey MP, et al.: Breast self-examination and survival from breast cancer. Br J Cancer 66: 917–918, 1992

    Google Scholar 

  61. Muscat JE, Huncharek MS: Breast self-examination in a population-based cancer registry. Cancer Detect Prev 15: 155–159, 1991

    Google Scholar 

  62. Newcomb PA, Weiss NS, Storer BE, et al.: Breast self-examination in relation to the occurrence of advanced breast cancer. J Natl Cancer Inst 83: 260–265, 1991

    Google Scholar 

  63. Smith EM, Burns TL: The effects of breast self-examination in a population-based cancer registry. Cancer 55: 432–437, 1985

    Google Scholar 

  64. Philip J, Harris WG, Flaherty C, et al.: Breast self-examination: clinical results from a population-based prospective study. Br J Cancer 50: 7–12, 1984

    Google Scholar 

  65. Kash KM, Holland JC, Halper MS, et al.: Psychological distress and surveillance behaviors of women with a family history of breast cancer. J Natl Cancer Inst 84: 24–30, 1992

    Google Scholar 

  66. Hoskins KF, Stopfer JE, Calzone KA, et al.: Assessment and counseling for women with a family history of breast cancer. A guide for clinicians. JAMA 273: 577–585, 1995

    Google Scholar 

  67. Burke W, Daly M, Garber J, et al.: Recommendations for follow-up care of individuals with an inherited predisposition to cancer. II BRCA1 and BRCA2. JAMA 277: 997–1003, 1997

    Google Scholar 

  68. Early Breast Cancer Trialists' Collaborative Group: Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 351: 1451–1467, 1998

    Google Scholar 

  69. Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-I Study. J Natl Cancer Inst 90: 1371–1388, 1998

    Google Scholar 

  70. Gail MH, Costantino JP, Bryant J, et al.: Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 91: 1829–1846, 1999

    Google Scholar 

  71. Veronesi U, Maisonneuve P, Costa A, et al.: Prevention of breast cancer with tamoxifen: Preliminary findings from the Italian randomized trial among hysterectomised women. Lancet 352: 93–97, 1998

    Google Scholar 

  72. Powles T, Eeles R, Ashley S, et al.: Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomized chemoprevention trial. Lancet 352: 98–101, 1998

    Google Scholar 

  73. Cumming S, Norton L, Echert S, et al.: Raloxifene reduces the risk of breast cancer and may decrease the risk of endometrial cancer in postmenopausal women. Two-year findings from the Multiple Outcomes Raloxifene Evaluation Trial. Proc Am Soc Clin Oncol 17: 2a, 1998

    Google Scholar 

  74. Jordan VC, Glusman JE, Eckert S, et al.: Raloxifene reduces incident primary breast cancers: Integrated data from mulicenter, double-blind, placebo-controlled, randomized trials in postmenopausal women. Breast Cancer Res Treat 50: 227, 1998 (abstr)

    Google Scholar 

  75. Cummings SR, Eckert S, Krueger KA, et al.: The effect of Raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 281: 2189–2197, 1999

    Google Scholar 

  76. Rebbeck TR, Levin AM, Eisen A, et al.: Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 91: 1475–1479, 1999

    Google Scholar 

  77. Peyrat JP, Vennin P, Hornez L, et al.: Mutations germinales de BRCA1 chez 36 patientes atteintes du cancer du sein et/ou de l'ovaire et appartenant B des familles B risque du Nord de la France. Bull Cancer 84: 41–46, 1997

    Google Scholar 

  78. Karp SE, Tonin PN, Begin LR, et al.: Influence of BRCA1 mutations on nuclear grade and estrogen receptor status of breast carcinoma in Ashkenazi Jewish women. Cancer 80: 435–441, 1997

    Google Scholar 

  79. Johannsson OT, Ranstam J, Borg A, et al.: Survival of BRCA1 breast and ovarian cancer patients: a population-based study from southern Sweden. J Clin Oncol 16: 397–404, 1998

    Google Scholar 

  80. Ansquer Y, Gautier C, Fourquet A, et al.: Survival in early onset BRCA1 breast cancer patients. Lancet 352: 541, 1998

    Google Scholar 

  81. Robson M, Gilewki T, Haas B, et al.: BRCA-associated breast cancer in young women. J Clin Oncol 16: 1642–1649, 1998

    Google Scholar 

  82. Verhoog LC, Brekelmans CTM, Seynaeve C, et al.: Survival and tumour characteristics of breast cancer patients with germline mutations of BRCA1. Lancet 351: 316–321, 1998

    Google Scholar 

  83. Osin P, Gusterson BA, Philp E, et al.: Predicted anti-oestrogen resistance in BRCA-associated familial breast cancers. Eur J Cancer 34: 1683–1686, 1998

    Google Scholar 

  84. van den Berg J, Jôhannsson O, Håkansson S, et al.: Allelic loss at chromosome 13q12-q13 is associated with poor prognosis in familial and sporadic breast cancer. Br J Cancer 74: 1615–1619, 1996

    Google Scholar 

  85. Bièche I, Noguès C, Rivoilan S, et al.: Prognostic value of loss of heterozygosity at BRCA2 in human breast carcinoma. Br J Cancer 76: 1416–1418, 1997

    Google Scholar 

  86. Verhoog LC, Brekelmans CTM, Seynaeve C, et al.: Survival in hereditary breast cancer associated with germline mutations of BRCA2. J Clin Oncol 17: 3396–3402, 1999

    Google Scholar 

  87. Hartmann LC, Schaid DJ, Woods JE, et al.: Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New Engl J Med 340: 77–84, 1999

    Google Scholar 

  88. Jarrett JR: Prophylactic mastectomy. In: Marsh JL (ed) Current Therapy in Plastic and Reconstructive Surgery. Deckker, Toronto, Ont, 1984, 64 pp

    Google Scholar 

  89. Pennisi VR, Capozzi A: Subcutaneous mastectomy data: a final statistical analysis of 1500 patients. Aesthetic Plast Surg 13: 15–21, 1989

    Google Scholar 

  90. Woods JE: Subcutaneous mastectomy. Current state of the art. Ann Plast Surg 111: 541–550, 1983

    Google Scholar 

  91. Gail MH, Brinton LA, Bjar DP, et al.: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81: 1879–1886, 1989

    Google Scholar 

  92. Schrag D, Kuntz KM, Garber JE, et al.: Decision analysis – effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. New Engl J Med 336: 1465–1471, 1997

    Google Scholar 

  93. Grann VR, Panageas KS, Whang W, et al.: Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive and BRCA2-positive patients. J Clin Oncol 16: 979–985, 1998

    Google Scholar 

  94. Stefanek M: Bilateral prophylactic mastectomy: issues and concerns. Monogr Natl Cancer Inst 17: 37–42, 1995

    Google Scholar 

  95. Eisen A, Weber BL: Prophylactic mastectomy – the price of fear. New Engl J Med 340: 137–138, 1999

    Google Scholar 

  96. Goodwin PJ: Lifestyle modification and prophylactic surgery. In: Perry MC (ed) ASCO Educational Book, Fall 1999, American Society of Clinical Oncology. Alexandria, VA, 1999, pp 215–220

  97. Howe GR, Hirohata T, Hislop TG, et al.: Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst 82: 561–568, 1990

    Google Scholar 

  98. Hunter DJ, Spiegelman D, Adami HO, et al.: Cohort studies of fat intake and the risk of breast cancer – a pooled analysis. N Engl J Med 334: 356–361, 1996

    Google Scholar 

  99. Greenwald P, Sherwood K, McDonald SS: Fat caloric intake and obesity: lifestyle risk factors for breast cancer. J Am Diet Assoc 97: S24–S30, 1997 (suppl)

    Google Scholar 

  100. Holmes MD, Hunter DJ, Colditz GA, et al.: Association of dietary intake of fat and fatty acids with risk of breast cancer. JAMA 281: 914–920, 1999

    Google Scholar 

  101. Hunter DJ, Willett WC: Nutrition and breast cancer. Cancer Causes Contr 7: 56–58, 1996

    Google Scholar 

  102. Zhang S, Hunter DJ, Hankinson SE, et al.: A prospective study of folate intake and the risk of breast cancer. JAMA 281: 1632–1637, 1999

    Google Scholar 

  103. Friedenreich CM, Thune I, Brinton LA, et al.: Epidemiologic issues related to the association between physical activity and breast cancer. Cancer 83: 600–610, 1998

    Google Scholar 

  104. Frisch RE, Wyshak G, Albright NL, et al.: Lower prevalence of breast cancer and cancers of the reproductive system among former college athletes compared to non-athletes. Br J Cancer 52: 88–91, 1985

    Google Scholar 

  105. Brinton LA, Bernstein L, Colditz GA: Summary of the workshop. Workshop on physical activity and breast cancer, November 13–14, 1997. Cancer 83: 595–599, 1998

    Google Scholar 

  106. Hunter DJ, Willett WC: Diet, body size and breast cancer. Epidemiol Rev 15: 110–132, 1993

    Google Scholar 

  107. Del Giudice ME, Fantus IG, Ezzat S, et al.: Insulin and related factors in premenopausal breast cancer risk. Breast Cancer Res Treat 47: 110–120, 1998

    Google Scholar 

  108. Henderson BE, Bernstein L: The role of endogenous and exogenous hormones in the etiology of breast cancer. In: Harris JR, Hellman S, Henderson IC, Kinne DW (eds) Breast Diseases, 2nd edition. Philadelphia, PA, Lippincott, 1991, pp 126–135

    Google Scholar 

  109. Collaborative Group on Hormonal Factors in Breast Cancer: Breast cancer and hormone replacement therapy: Collaborative re-analysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet 350: 1047–1059, 1997

    Google Scholar 

  110. Schairer C, Lubin J, Troisi R, et al.: Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA 283: 485–491, 2000

    Google Scholar 

  111. Ross RK, Paganini-Hill A, Wan PC, et al.: Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst 92: 328–332, 2000

    Google Scholar 

  112. Collaborative Group on Hormonal Factors in Breast Cancer: Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 347: 1713–1727, 1996

    Google Scholar 

  113. Narod SA, Risch H, Moslehi R, et al.: Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Group. New Engl J Med 339: 424–428, 1998

    Google Scholar 

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Goodwin, P.J. Management of familial breast cancer risk. Breast Cancer Res Treat 62, 19–33 (2000). https://doi.org/10.1023/A:1006470206271

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