Those at a Higher-Than-Average Risk of Being Diagnosed with Cancer Individuals at a higher-than-average risk of being diagnosed with cancer are those who have a strong family history of cancer, a personal history of cancer, certain tissue makeup, an inherited genetic condition, or are exposed to one or more cancer risk factors, all of which place them at a higher risk of developing cancer. One example is individuals who consume tobacco products. According to CDC, people who smoke cigarettes are 15 to 30 times more likely to develop lung cancer or die from it than people who do not smoke. Women with extremely dense breast tissue are considered at higher-than-average risk of developing breast cancer compared to women with less dense breast tissue. Because of gaps in the current knowledge, USPSTF does not recommend additional screening tests for women with extremely dense breasts in the recently released draft statement of the revised recommendations for breast cancer screening (284). However, other cancer-focused organizations do recommend additional screening tests for women with dense breast tissue (285). Furthermore, 38 U.S. states currently require some level of breast density-related notification after a mammogram, and many provide expanded insurance coverage for additional screening for those who have dense breast tissue (286). It is important to note that extremely dense breast tissue is only one of many risk factors for breast cancer. More research is necessary to determine why women with dense breast tissue are at a higher-than-average risk of being diagnosed with breast cancer and whether this knowledge can be used to improve risk prediction models for breast cancer. Another group of individuals at higher-than-average risk of being diagnosed with cancer is people with inherited cancer susceptibility syndromes (or hereditary cancer syndromes), which are caused by genetic mutations that can be passed on from one generation to the next and can predispose an individual to develop certain types of cancer (see Figure 5, p. 31). For example, individuals who have Lynch syndrome, which is caused by mutations in genes important for repairing damaged DNA, have an increased risk of developing colorectal cancer, endometrial cancer, ovarian cancer, and many other types of cancer. USPSTF recommends that individuals with a personal or family history of Lynch syndrome should speak with their health care providers about appropriate screening options (288). Individuals who consider themselves at a high risk for an inherited cancer-predisposing genetic mutation should, in consultation with their health care providers, also consider genetic counseling and testing. Expert panels sometimes issue guidelines for genetic counseling and testing. For example, in 2019, USPSTF issued recommendations for breast cancer risk assessment, genetic counseling and genetic testing for women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or an ancestry associated with BRCA1/2 gene mutation (see Figure 12, p. 62) (289). Genetic testing may aid individuals and their health care teams in deciding whether, increased frequency of breast cancer screening with MRI, preventive surgery (see Supplemental Table 1, p. 191), or chemoprevention (e.g., use of selective estrogen receptor modulators) would help reduce the risk of developing cancer later on in life. It is concerning that only 6.8 percent of more than 1.3 million people had undergone genetic testing, according to a recent study examining the extent of germline mutations among people diagnosed with cancer (290). It is imperative that individuals who are at a high risk for being diagnosed with cancer because of inherited mutations consult with their care team for whether or when they should undergo genetic testing. Suboptimal Uptake of Cancer Screening Evidence shows that adherence to recommended cancer screening saves lives (see Importance of Cancer Screening, p. 54). In a recent study, researchers found that 80 percent of the study participants who received a diagnosis of lung cancer at an early stage via routine lung cancer screening were living 20 years after the initial diagnosis (291). Despite the benefit of lung cancer screening, unfortunately, only six percent of U.S. individuals eligible for lung cancer screening were up to date with the recommended screening in 2022 (236). It is equally important to know when an individual should stop screening for cancer. USPSTF recommendations include the age WHAT IS DENSE BREAST TISSUE? Density of the breast tissue in a mammogram is determined by the comparative amounts of fibrous, glandular, and adipose tissues that make up the breast. The higher the amount of fibrous and glandular tissue, the denser the breast tissue appears in the mammogram. In March 2023, FDA issued updated guidance, requiring mammography facilities to notify patients about the density of their breasts (287). Screening for Early Detection AACR Cancer Progress Report 2023 61
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