Advising women at high risk of breast cancer.

Women with any family history of breast cancer assume a high probability of risk. Counseling women involves ascertainment of an accurate family history and use of the best predictive models to assess both the risk of a known mutation and the risk of breast cancer. This risk must then be considered in the contexts of both the women's lifetime and the next decade, in each instance carefully separating the risk of developing cancer from the risk of mortality. These two risks are often emotionally melded in women who have watched a loved one die of cancer. The options for a woman at significantly increased risk of breast cancer include optimal surveillance, chemoprevention, and prophylactic surgery. This entire field is in continuing evolution as better methods of diagnosis, screening, and chemoprevention continue to enter clinical practice.