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 can take steps to reduce your risk of breast and ovarian cancer.

Thinking about cancer risk

Experts know that women who have a BRCA gene change are more likely than average women to get breast cancer and ovarian cancer.

Comparing cancer risk^{footnote 1}
	Number who will get breast cancer	Number who will get ovarian cancer
Average women	About 12 out of 100	About 1 out of 100
Women with BRCA1 changes by age 70	About 57 to 60 out of 100	About 40 to 59 out of 100
Women with BRCA2 changes by age 70	About 49 to 55 out of 100	About 17 to 18 out of 100

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 changes^{footnote 2}
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 changes^{footnote 2}
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 counsellor 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.

References

Citations

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.

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.