Assessing a family history of cancer with FRA-BOC
FRA-BOC uses a maximum of eight questions to provide an estimation of risk.
It captures information about a woman’s 1° (parents, siblings, children) and 2° (aunts, uncles, nieces, nephews, grandparents) relatives on both sides of the family. However, FRA-BOC assesses family history of breast and ovarian cancer on each side of the family separately.
FRA-BOC begins the assessment with questions about family history of invasive epithelial ovarian cancer.
As ovarian cancer is less common than breast cancer in the population, a family history of ovarian cancer can sometimes be a stronger predictor of risk than family history of breast cancer. Where there is no history of ovarian cancer, a series of questions are then asked about breast cancer family history.
FRA-BOC asks about Ashkenazi Jewish ancestry.
Although genetic factors that may influence the risk of developing breast cancer are found in people of all nationalities, some are more common in people of Ashkenazi Jewish ancestry (Jews whose origins can be traced back to Eastern Europe) than in members of the general population. In Australia, most Jewish families are of Ashkenazi ancestry, so FRA-BOC simply uses the term ‘Jewish ancestry’. As many as one in 40 individuals (men and women) of Ashkenazi Jewish descent has one of the three founder mutations (faults) in the breast/ovarian cancer susceptibility genes BRCA1 and BRCA2. Women who carry such a gene fault have a high lifetime risk of breast cancer, estimated to be in the range of 30-60%, and a lifetime ovarian cancer risk of about 20%.
Family history should be updated regularly – it may change with time
An absence of family history does not mean there is no risk of breast/ovarian cancer.
A FRA-BOC risk assessment places a woman within one of three broad risk categories. This helps determine appropriate management e.g. reassurance or possible referral to a family cancer clinic for further assessment.
FRA-BOC uses sufficient information to determine a risk category, so in some cases additional questions, such as whether a woman has a relative with bilateral breast cancer, will not appear.