Breast Cancer Risk Assessment and How to Discuss Issues with Patients

When assessing Breast Cancer Risk, there are two questions to be answered: the chances of developing breast cancer over a given timespan (including the lifetime) and the chances of being a mutation carrier of known high-risk genes such as BRCA1 or BRCA2. There are multiple Models to assess individual BC risk like the Gail model, Claus, BRCAPRO and Cuzick-Tyrer. While some models are aiming primarily at solving one of the questions, many also have an output for the other. Clinically, there is a certain process to be followed: a) assessment by non-genetics specialist and possible decision for further referral, b) evaluation by genetic counsellor and decision for testing, c) genetic testing and discussion of the result and d) decision on further steps (intensive screening, risk-reducing medications or prophylactic surgery). However, it is very important how to discuss issues with the patient and how to avoid pitfalls in risk communication. There are multiple personal, social and ethical implications that a woman should know beforehand. Issues on communication such as presentation of relative and absolute risk, framing of the information and mainly risk perception have to be taken carefully into account. While communicating breast cancer risk, each step requires careful interpretation of information, consideration of future risks, and shared decision making before moving on to the next step. As risk perception is bound up with serious decisions and actions, services must be well integrated and highly individualized in order to optimize benefits and minimize harms for patients as well as their families.