title: Identification and management of women with a family history of breast cancer: Practical guide for clinicians.
abstract: OBJECTIVE
  To summarize the best evidence on strategies to identify and manage women with a family history of breast cancer.
  
  
  METHODS
  A PubMed search was conducted using the search terms breast cancer, guidelines, risk, family history, management, and magnetic resonance imaging screening from 2000 to 2016. Most evidence is level II.
  
  
  RESULTS
  Taking a good family history is essential when assessing breast cancer risk in order to identify women suitable for referral to a genetic counselor for possible genetic testing. Offering risk-reducing surgery (bilateral prophylactic mastectomy, bilateral salpingo-oophorectomy) to women with BRCA genetic mutations can save lives. All women with a family history of breast cancer should be encouraged to stay active and limit alcohol intake to less than 1 drink per day; some will qualify for chemoprevention. Women with a 20% to 25% or greater lifetime risk of breast cancer should be offered enhanced screening with annual magnetic resonance imaging in addition to mammography.
  
  
  CONCLUSIONS
  Healthy living and chemoprevention (for suitable women) could reduce breast cancer incidence; enhanced screening could result in earlier detection. Referring women who carry BRCA mutations for risk-reducing surgery will save lives.
authors.affiliation: Chief of Family and Community Medicine at Women's College Hospital in Toronto, Ont, a GP-oncologist at Princess Margaret Hospital in Toronto, and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine at the University of Toronto. ruth.heisey@wchospital.ca.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heisey
authors.affiliation: Family physician in the Granovsky Gluskin Family Medicine Centre at Mount Sinai Hospital in Toronto and Clinician Scientist and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
mesh_terms: D019313:BRCA1 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics*; D002170:Canada; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005820:Genetic Testing; D006579:Heterozygote; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human