Reducing Cancer Risk When You Are BRCA-Positive

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Topic Overview

If you've found out that you have a BRCA gene change, you may be feeling pretty overwhelmed. But when it comes to cancer, knowledge is power. Now that you know you are BRCA-positive, you can take steps to reduce your risk of breast and ovarian cancer.

Thinking about cancer risk

Experts know that women who are BRCA-positive are more likely than average women to get breast cancer and ovarian cancer. This table shows the predicted number of women in each group who will get cancer by age 70.

Comparing cancer riskfootnote 1
 Number who will get breast cancerNumber who will get ovarian cancer
Average womenAbout 12 out of 100About 1 out of 100
Women with BRCA1 changes by age 70About 57 to 60 out of 100About 40 to 59 out of 100
Women with BRCA2 changes by age 70About 49 to 55 out of 100About 17 to 18 out of 100

It's clear that having a BRCA change makes a big difference. But it's important to realize that:

  • If about 57 to 60 out of 100 women with BRCA1 changes get breast cancer, this means that about 40 to 43 out of 100 of them don't get it.
  • About 41 to 60 out of 100 women with BRCA1 changes don't get ovarian cancer.
  • About 45 to 51 out of 100 women with BRCA2 changes don't get breast cancer.
  • About 82 to 83 out of 100 women with BRCA2 changes don't get ovarian cancer.

But no one can predict who will or won't get cancer or when. That's why experts suggest that all women with BRCA changes take steps to prevent cancer.

Ways to reduce cancer risk

To help women with BRCA changes, some experts did a study that let them predict how much breast and ovarian cancer risk could be reduced by:

  • Having the breasts removed (mastectomy).
  • Having the ovaries removed (oophorectomy).
  • Having a mammogram and breast MRI every year starting at age 25. These screening tests don't prevent breast cancer. But they can find cancer early, when a cure is most likely.

The study also looked at having the surgeries at different ages. So for example, you can see what difference it might make if you keep your breasts and ovaries until after you are done having children. These results are one piece of information you can use as you explore how to lower your cancer risk.

Surgery and screening tests are not your only choices. You can also talk to your doctor about preventive medicines such as tamoxifen. And some women choose to have no treatment or extra screening.

Women with BRCA1 changes

According to the study, here's how the different prevention methods affect the life spans of women with BRCA1 changes.

Comparing prevention methods for women with BRCA1 changesfootnote 2
Prevention methodWomen who live to age 70 after this method
No treatment or extra screening53 out of 100
Annual breast screening59 out of 100
Ovaries removed at age 5061 out of 100
Breasts removed at age 4064 out of 100
Breasts removed at age 2566 out of 100
Ovaries removed at age 4068 out of 100
Annual screening + ovaries removed at age 4076 out of 100
Annual screening + breasts and ovaries removed at age 4077 out of 100
Breasts removed at age 25 + ovaries removed at age 4079 out of 100

Women with BRCA2 changes

According to the study, here's how the different prevention methods affect the life spans of women with BRCA2 changes.

Comparing prevention methods for women with BRCA2 changesfootnote 2
Prevention methodWomen who live to age 70 after this method
No treatment or extra screening71 out of 100
Annual screening75 out of 100
Ovaries removed at age 5075 out of 100
Ovaries removed at age 4077 out of 100
Annual screening + breasts removed at age 4078 out of 100
Breasts removed at age 2579 out of 100
Annual screening + ovaries removed at age 4081 out of 100
Annual screening + breasts and ovaries removed at age 4082 out of 100
Breasts removed at age 25 + ovaries removed at age 4083 out of 100

What should you do now?

Take some time to think about your options. A genetic counselor can help you understand how the prevention options affect your cancer risk. Discuss them with your family and close friends. Then you can reach a decision that feels right for you.

Breast Cancer: What Should I Do if I'm at High Risk?
Ovarian Cancer: Should I Have My Ovaries Removed to Prevent Ovarian Cancer?

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References

Citations

  1. National Comprehensive Cancer Network (2015). Genetic/familial high-risk assessment: Breast and ovarian. NCCN Clinical Practice Guidelines in Oncology, version 1.2015. http://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed June 2, 2015.
  2. Kurian AW, et al. (2010). Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. Journal of Clinical Oncology, 28(2): 222-231. Also available online: http://jco.ascopubs.org/content/28/2/222.full.

Other Works Consulted

  • Domchek SM, et al. (2010). Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA, 304(9): 967-975. Also available online: http://jama.jamanetwork.com/article.aspx?articleid=186510.
  • National Cancer Institute (2011). Genetics of Breast and Ovarian Cancer (PDQ)-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.

Credits

ByHealthwise Staff

Primary Medical ReviewerSarah Marshall, MD - Family Medicine

E. Gregory Thompson, MD - Internal Medicine

Kathleen Romito, MD - Family Medicine

Specialist Medical ReviewerWendy Y. Chen, MD, MPH, MD, MPH - Medical Oncology, Hematology

Current as ofMay 3, 2017

Current as of: May 3, 2017

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Wendy Y. Chen, MD, MPH, MD, MPH - Medical Oncology, Hematology