Breast Cancer Genetics: The Role of Your Family Physician Part 3

Tuesday was another amazing day of learning & renewal.  The Congress of Delegates heard from several passionate candidates for the Board of Directors as well as Directors vying for President-Elect of this amazing group of people.  The energy & enthusiasm was quite palpable and aptly summed up by one speaker thusly: Being a family physician is the best job EVER!  So after a long day, I crawled back to my room to attempt to catch up on my journals (especially after Nevada State Senator Joe Hardy asked me point blank why I hadn't been actively blogging as I had previously).

Earlier this spring, a day after our taxes were due to be filed, the United States Preventive Services Task Force (USPSTF) published a systematic review of breast cancer chemoprophylaxis in the Annals of Internal Medicine.  Not even a month later, actress & mother Angelina Jolie surprised the world with her announcement of having underwent prophylactic double mastectomy due to her increased genetic risk for breast & ovarian cancer.

So what are the women in our lives to do?  Surgery vs pills?  Follow in the footsteps of a famous actress?  Luckily, the USPSTF followed up their systematic review with a Grade B recommendation statement published online yesterday in the same Annals of Internal Medicine which concluded that women at increased risk for breast cancer, as determined by the Gail Model, and who are also at lower risk for side effects, be given the option to consider chemoprophylaxis in the form of tamoxifen or raloxifene.  On the other hand, the USPSTF also gave a Grade D recommendation statement against the routine use of said chemophylaxis in those women who are not at increase risk for breast cancer.

Most importantly, the USPSTF recognized the importance of shared informed decision making in which our patients are given enough information at an appropriate level of understanding to make a decision consistent with their stated goals & desires.  Of note, these recommendation statements apply only to those women >35yo who are w/o diagnosis of either breast cancer or carcinoma in situ.

Aside from propitious timing, why discuss this article?  Because as family physicians, we care for the whole patient, the whole family, the whole community.  Because as family physicians, we prevent disease, rather than just treat it.  Because as family physicians, we help our patients understand all the options available to them.  And we help each one decide what's best for her (or him) at that stage in life.  And finally, because as family physicians, we are not gatekeepers; we practice comprehensive care w/o discrimination, regardless of gender, age, setting (be it rural or urban, outpatient or inpatient) or any other laundry list item.  We are vital to the foundation to a healthy America.  We have the best job EVER!

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