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Breast Cancer Risk

Using Real Medical Histories to Rank Genetic and Environmental Influences


Michèle I. Shuster
Department of Biology
New Mexico State University
Karen Peterson
Human Biology Division
Fred Hutchinson Cancer Research Center


This case study takes a combined directed and discussion approach to explore risk factors for breast cancer. After a preparatory reading assignment, students assess various medical histories derived from actual women with breast cancer and rank their overall risk for breast cancer and make recommendations for risk reduction. The task is complicated by the different and often combined sources of risk (e.g., reproductive history, hormone replacement therapy and family history). Originally written for an introductory biology course, the case study could easily be adapted for upper division curses in genetics, physiology, or biochemistry to explore the biological and biochemical basis underlying various risk factors.


Introductory Course Goals

  • To learn about risk factors for breast cancer and assess whether a risk factor is controllable or uncontrollable.
  • To use provided clinical histories to assess the overall cancer risk of four different women, and then rank these women based on overall breast cancer risk.
  • To make recommendations for each woman on how she should act to reduce her breast cancer risk.

Possible Goals for Upper Division Courses (e.g., Genetics, Physiology, Biochemistry)

  • To learn about the cellular roles of BRCA1 and BRCA2.
  • To articulate the pathways of estrogen synthesis in pre-menopausal and post-menopausal women.
  • To understand the basis for oral contraceptives and hormone replacement therapy (HRT).
  • To describe the technical aspects of the BRCA1 and BRCA2 gene tests.
  • To explain the significance and limitations of positive and negative BRCA1 and BRCA2 gene tests on overall risk of breast and ovarian cancer.
  • To search the primary literature for studies that attempt to link epidemiological data on diet and cancer risk to a biological basis underlying such epidemiological observations, then present the key experiments to the class.
  • Given a written (narrative) family history, draw a pedigree for that family and to determine the apparent mode of inheritance (for breast cancer or another type of cancer).


Breast cancer risk factors; family history; pedigree chart; reproductive history; clinical history; estrogen; BRCA1; BRCA2; oncogenes

Topical Areas


Educational Level

High school, Undergraduate lower division, Undergraduate upper division, Clinical education



Type / Methods

Directed, Discussion



Subject Headings

Bioinformatics  |   Physiology  |   Genetics / Heredity  |   Epidemiology  |   Biochemistry  |  

Date Posted


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Dawn Lewis
East High School
Erie, PA
I really enjoyed doing this case study with my high school genetics class! My only comment would be to add a male in as a patient. I always try to stress to my students that males can also have breast cancer and that would help stress the importance of this. Thank you!