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Familial Risk of Breast Cancer - Coggle Diagram

- - - - BRCA1
        
        MElanoma
        
        Colorectal
      - BRCA2
        
        PAncreatic
        
        Hepatic
        
        Prostatic
        
        Male breast Ca
- - - - Location
        
        Mx primary care
      - Management
        
        Reassurance
        No need for early breast screening
        Education regarding breast awareness and healthy lifestyle behaviour
        Inform pt to be aware of changes in fhx
        Follow up in primary care and commence screening with Breast Check
    - - Location
        
        Regional cancer centre at specific risk assessment clinic
      - Management
        
        Annual Cliniacl Breast Examination at family risk clinic
        Annual mammography age 40-49
        .>50 mammography with Breast Check
        Education / information re breast awareness and lifestyle
    - - Location
        
        Clinical cancer geneticist and Team
      - Management
        
        6 monthly clinical exam
        Annual mammography for women age >40 (not for TP53)
        Annual MRI age 30-49 if high risk categories relfects one or more of following:
        
        TP53, BRCA1, BRCA2
        
        Women not tested but are high chance of carryig BRCA or TP53 mutation
- - - - Prophylactic MAstectomy
        95% risk reduction
        Survival benefit not well established
      - Prophylactic Oopphorectomy
        Breast cancer risk reduction up to 50%
        80% reduction in ovarian / peritoneal malignnacy
        Survival benefit demonstrated
      - Timing
        
        BRCA1
        
        60-80% lifetime risk BC
        Age 30-39 RR BC is 33
        Age 60-69 RR BC is 14
        Higher incidence of TNBC
        
        BRCA2
        
        40-85% Lifetime risk of BC
        Penetrance more variable
        Receptor profile more like sporadic cancer
    - - Tamoxifen
        Lots of s/e
        Poor uptake
- - - - DIEP - Deep Inferior Epigastric Perforator Flap
        Fat, skin, blood vessel
        Free Flap