A healthy 47-year-old woman wants your recommendations for breast cancer prevention because her…

A healthy 47-year-old woman wants your recommendations for breast cancer prevention because her mother had breast cancer at age 59. Th e patient performs regular breast self-examinations and practices breast self-awareness, and she has noticed no changes. She began having mammograms at age 40 and has had no abnormalities; her latest mammogram 13 months ago was unremarkable, showing only dense tissue. Her past medical history is unremarkable. Her latest menstrual period was 1 month ago, but the period before that one was 9 months earlier; before that, her menses had been irregular. Family history is otherwise notable for ovarian cancer in her maternal aunt at age 61, breast cancer in her maternal grandmother at age 63, prostate cancer in her maternal uncle at age 52, and pancreatic cancer in her maternal great grandfather at age 67. Findings on her physical examination, including breast examination, are normal. Th e mammogram done the same day is normal and unchanged compared with prior mammograms. Dense tissue is still observed. You recommend a medical genetics consultation to further evaluate her family history because you are concerned about the possibility of hereditary breast and ovarian cancer syndrome. Th ree weeks later, the patient returns and reports that her mother accompanied her to the genetics consultation. Th e geneticist estimated that the patient’s mother had a 24% likelihood of a mutation; thus, the patient has a 12% likelihood. Th e patient’s mother was tested and the patient has learned that her mother carries a truncation mutation in BRCA2 . Which of the following should you recommend that the patient consider as her next step? a. Annual digital mammogram and clinical breast examination b. Bilateral mastectomy and oophorectomy c. Tamoxifen 20 mg daily for 5 years d. Raloxifene 60 mg daily for 5 years e. Genetic testing