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Reducing Cancer Risk When You Are BRCA-Positive

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 risk1
  Number who will get breast cancer Number who will get ovarian cancer
Average women 12 in 100 1 in 100
Women with BRCA1 changes 84 in 100 40 in 100
Women with BRCA2 changes 35 in 100 20 in 100

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

  • If 20 in 100 women with BRCA2 changes get ovarian cancer, this means that 80 in 100 of them don't get it.
  • About 60 in 100 women with BRCA1 changes don't get ovarian cancer.
  • About 65 in 100 women with BRCA2 changes don't get breast cancer.

The problem is that 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 can 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 changes2
Prevention method Women who live to age 70 after this method
No treatment or extra screening 53 out of 100
Annual breast screening 59 out of 100
Ovaries removed at age 50 61 out of 100
Breasts removed at age 40 64 out of 100
Breasts removed at age 25 66 out of 100
Ovaries removed at age 40 68 out of 100
Annual screening + ovaries removed at age 40 76 out of 100
Annual screening + breasts and ovaries removed at age 40 77 out of 100
Breasts removed at age 25 + ovaries removed at age 40 79 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 changes2
Prevention method Women who live to age 70 after this method
No treatment or extra screening 71 out of 100
Annual screening 75 out of 100
Ovaries removed at age 50 75 out of 100
Ovaries removed at age 40 77 out of 100
Annual screening + breasts removed at age 40 78 out of 100
Breasts removed at age 25 79 out of 100
Annual screening + ovaries removed at age 40 81 out of 100
Annual screening + breasts and ovaries removed at age 40 82 out of 100
Breasts removed at age 25 + ovaries removed at age 40 83 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.

Click here to view a Decision Point.Breast Cancer: What Should I Do if I'm at High Risk?
Click here to view a Decision Point.Ovarian Cancer: Should I Have My Ovaries Removed to Prevent Ovarian Cancer?

References

Citations

  1. U.S. Preventive Services Task Force (2005). Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement. Annals of Internal Medicine, 143(5): 355–361.
  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

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Douglas A. Stewart, MD - Medical Oncology
Current as of June 28, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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