Everyone should know their family history of breast cancer. But when it comes to risk factors for triple-negative breast cancer (TNBC), the stakes are higher for some women of color. TNBC is diagnosed most often in and is deadliest for young Black women. Cases are also higher among Hispanic women.
You may not be able to avoid this type of cancer. But knowing your family history can give you a head start on catching the disease early.
Whose Health History Matters Most?
Start by taking a close look at your first-degree family members. These are blood relatives, including your parents, siblings, and kids. They share half your DNA, and your chances of breast cancer doubles or triples if one or two of these direct relatives have breast cancer.
It’s also a good idea to find out the health history of any close kin.
“We’re talking mom, sister, aunts, grandmother,” says Kimberley Lee, MD, a breast oncologist at Moffitt Cancer Center. “And if you know about family further out, cousins and so on, that’s great.”
What if different kinds of cancer show up in a couple of your distant relatives who aren’t related to each other? Is that enough to boost your genetic risk of TNBC? Probably not, according to breast cancer experts.
“If I meet a woman who says my great aunt had breast cancer on my mother’s side, and my dad’s second cousin had ovarian cancer, that’s not worrisome for hereditary cancer syndrome,” says Rachel Greenup, MD, chief of breast surgery with Yale Medicine.
A strong family history of breast or ovarian cancer isn’t the only thing that raises your risk of TNBC. Age is another big factor. If a close relative is diagnosed early, especially before the age of 50, “that makes a difference for the risk that it’s a familial breast cancer,” Greenup says.
Other risk factors include a personal history of any kind of breast cancer or if one or more of your direct relatives is diagnosed with the following:
- Early prostate cancer (at age 55 or younger)
- Melanoma
- Pancreatic cancer
Talk to your doctor about any TNBC concerns because of family history. Try to find answers to these questions before your visit:
- Have multiple family members had the same kind of cancer?
- Are there men in your family who’ve had breast cancer?
- Does cancer show up across generations on the same side of the family?
- Do you have family members who’ve had more than one kind of cancer?
- Did someone have ovarian or breast cancer that spread to other parts of the body?
- Have any family members had cancer in both breasts?
Should You Get Genetic Testing?
Breast cancers aren’t typically passed down through families. But there’s a strong association between TNBC and the BRCA1 gene mutation. This link “is significantly higher compared to other kinds of breast cancer,” Greenup says.
There’s evidence that 20% to 35% of Black women with TNBC may test positive for the BRCA1 gene mutation. And there’s a 50/50 chance you’ll have one of these mutations if your mother or father has one.
Most of what we currently know about familial breast cancer is based on the genes of white people. There’s ongoing research to pinpoint TNBC-related variants that may show up more often in other races and ethnicities.
So far, besides the BRCA1 gene, the following genetic mutations raise your odds of TNBC:
- PALB2
- BARD1
- BRCA2
- RAD51D
Experts may suggest multigene tests down the road. But the current national guidelines suggest genetic testing only for BRCA1 or BRCA2 genes if:
- You have a family history of breast or ovarian cancer
- You or a close family member is diagnosed with TNBC at age 60 or younger
- You’re diagnosed with any breast cancer at age 50 or younger.
Still not sure if genetic testing is right for you? Ask your primary care doctor or gynecologist to review your cancer history.
“They can determine whether or not you need a referral to a high-risk breast cancer clinic or genetic counseling,” Lee says.
Bring up genetic services even if your doctor doesn’t, especially if you’re from a racial or ethnic minority group. Studies show Black women are more likely to meet the standards for genetic testing or counseling but don’t get referred as often as non-Hispanic white women.
If you have health coverage, most insurers will cover some or all the costs of genetic testing. But you must meet national guidelines that put you in the high-risk breast cancer group.
“That’s why the evaluation is so important,” Lee says. “You do have to document your risk.”
Family History and Metastatic Triple-Negative Breast Cancer (mTNBC) Treatment
All breast cancers are tough to get rid of once they’ve spread to other parts of your body. But mTNBC presents more of a challenge because there are no hormones to target. But the number of therapies available is growing. And while your family history doesn’t directly affect treatment, your genes and the genes in your tumor may change the kind of anti-cancer drugs your doctor uses.
For example, you may benefit from standard treatment along with newer drugs like immunotherapy, drug-antibody conjugates, or PARP inhibitors.
“The mainstay of treating triple-negative breast cancer is chemotherapy” Lee says. “But there’s a lot of work going on to try to find new agents and new combinations of agents to improve treatment.”
How Does Family History Affect Breast Cancer Screening?
Women with an average risk for breast cancer should get mammograms starting around age 40 to 45, according to the American Cancer Society. This includes folks who have no direct relatives with breast or ovarian cancer or only one second-degree female family member who was diagnosed with breast cancer after age 50.
But if you have a strong family history of breast or ovarian cancer, your doctor might urge screenings earlier than normal, according to Eric Winer, MD, director of the Yale Cancer Center. And you might qualify for more detailed scans with an annual breast MRI starting around age 30.
If you have a BRCA mutation, you can talk to your doctor about extra steps to prevent cancer. Some women choose to get more frequent screenings or to have their breasts or ovaries removed.
You may wonder if your race or ethnicity alone is enough to warrant breast cancer checks at an earlier age. But, Winer says, there’s no agreed-upon recommendation that says all Black (or Hispanic) women should start screenings before age 40.
But it’s a good idea to talk to your doctor about your breast cancer risk by age 30.
If you have a family history of breast or ovarian cancer, even a small one, be extra aware of signs and symptoms of breast cancer. And when you notice a lump, mass, or change in your breast at any point, “promptly seek medical attention,” Winer says.
Show Sources
Photo Credit: kate_sept2004 / Getty Images
SOURCES:
Kimberley Lee, MD, assistant member, department of breast oncology, Moffitt Cancer Center.
Rachel Greenup, MD, associate professor of surgery (oncology, breast), Yale School of medicine; chief, breast surgery, The Breast Center at Smilow Cancer Hospital.
Anne Marie McCarthy, PhD, assistant professor of epidemiology, Perelman School of Medicine, University of Pennsylvania.
Eric Winer, MD, professor of pharmacology; professor of medicine (medical oncology), Yale School of Medicine; director, Yale Cancer Center; physician-in-chief, Smilow Cancer Network.
Frontiers in Molecular Biosciences: “Triple-Negative Breast Cancer: A Brief Review About Epidemiology, Risk Factors, Signaling Pathways, Treatment and Role of Artificial Intelligence.”
American Cancer Society: “Breast Cancer Risk Factors You Cannot Change,” “Study: New Genes Linked With Triple-Negative Breast Cancer,” “American Cancer Society Recommendations for the Early Detection of Breast Cancer.”
Journal of the National Cancer Institute: “Triple-Negative Breast Cancer Risk Genes Identified by Multigene Hereditary Cancer Panel Testing.”
CDC: “Family Health History and the BRCA1 and BRCA2 genes,” “Family Health History Risk Categories,” “BRCA Gene Mutations.”
Current Breast Cancer Reports: “Disparities in Genetic Testing and Care among Black women with Hereditary Breast Cancer.”
JAMA Surgery: “Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients.
