If you tested for the BRCA gene mutation and received a positive result, you may be considering your next steps. There are actions you can take now to reduce the likelihood of developing breast cancer or ovarian cancer in the future. While some of them are significant steps toward risk reduction, it’s important to know your options and take the actions you’re most comfortable with.
Below are a few things BRCA-positive women can do to reduce the risk of breast and ovarian cancer.
Key Risk-Reducing Options to Consider After Testing BRCA-Positive
When you test BRCA-positive, your oncologist may discuss one or more of the following options with you:
- Regular screening (mammogram, ultrasound, and MRI)
- Breast surgery (mastectomy)
- Ovary removal surgery (oophorectomy)
- Chemoprevention (medication)
- Healthy lifestyle choices
Since the risk of developing breast cancer or ovarian cancer for patients who test BRCA-positive is up to six times greater than those who don’t, these preventive measures require special attention.
1. Regular Breast Cancer and Ovarian Cancer Screening
Early detection is the key to timely treatment and positive outcomes.
Breast cancer screening for men and women who are BRCA-positive
- While doctors recommend starting annual breast cancer screenings at the age of 40, BRCA-positive women may start regular mammograms as early as 25. Regardless of your age, when you receive a BRCA-positive test result, talk to your doctor about the right breast cancer screening schedule for you.
- When possible, request a 3D mammogram. The 3D technology detects smaller tumors sooner than standard mammography.
- Talk to your doctor about doing annual breast MRIs in addition to mammograms. These shouldn’t replace mammograms, but studies show the combination of both can help those at high risk find cancer sooner.
- Have a clinical breast exam 1-2 times per year.
- BRCA-positive men should consider beginning breast cancer screening and self-exams at age 35.
Ovarian Cancer Screening for BRCA-positive women
While there are no ovarian cancer screening tests for those at average risk, some options are available for those at high risk.
- Be sure you have a clinical pelvic exam at least once a year starting at age 25.
- The CA-125 blood test looks for a special protein that can indicate the presence of ovarian cancer. This isn’t a standard blood test but is available for women at high-risk.
- Between ages 30 and 35, the pelvic exam may also include a transvaginal ultrasound to check for the development of ovarian tumors. While the ultrasound can't tell if tumors are cancerous, it can give your doctor an indication of whether they should do further testing.
Frequent screenings don't guarantee early cancer detection; however, they increase your chances of discovering it earlier. Earlier detection means easier treatment.
Your doctor can explain which regular screening methods may be right for you depending on your personal factors and set up a customized early detection plan.
2. Preventive Mastectomy
Some women may consider surgically removing both breasts to prevent breast cancer development. Opting for a preventative (also called prophylactic) mastectomy is a serious decision and may not be right for each BRCA-positive woman.
When considering such a surgery, you, and your partner, should discuss it with your doctor and the breast surgeon to understand your options, recovery time, and what life would be like after the surgery.
It's important to note that a preventive mastectomy doesn't eliminate the risk of developing breast cancer entirely.
- For women who tested positive for BRCA1 and BRCA2 mutations, a mastectomy can reduce the risk by 90 to 95%.
- Women who already had breast cancer and have a family history of this problem can reduce the risk of developing cancer in another breast by 90% to 95%.
- Pre-menopausal women with estrogen receptor-negative breast cancers can gain a higher survival advantage by undergoing a preventative mastectomy.
It's possible to combine a prophylactic mastectomy with immediate reconstruction to maintain an aesthetic appearance of the breasts. A breast surgeon would be able to give you more information about reconstruction options.
3. Preventative Oophorectomy
Surgically removing both ovaries for BRCA-positive women can help prevent both breast and ovarian cancers. About 70% of women in the United States choose to have preventative (prophylactic) oophorectomy when they learn about their BRCA mutations.
Experts also recommend women with BRCA1 mutations have their fallopian tubes removed along with their ovaries (bilateral salpingo-oophorectomy) if they are done having children.
Just as with a mastectomy, preventative oophorectomy doesn't offer 100% breast or ovarian cancer risk prevention.
- In postmenopausal women, preventative oophorectomy can reduce breast cancer risks by up to 50%.
- Prophylactic oophorectomy can reduce ovarian cancer risk by 80% to 90%.
The onset of hereditary ovarian cancer for high-risk women usually occurs between 35 and 45 years of age. When possible, high-risk women should try to complete their families by age 40.
4. Chemoprevention
Chemoprevention or using medications to prevent cancer is another option for people who test BRCA positive. The treatment is highly individual and must be discussed with an oncologist. Each drug comes with a variety of counter-indications and side effects.
Selective Estrogen Receptor Modulators
Tamoxifen is a Selective Estrogen Receptor Modulator (SERM). It blocks the effects of estrogen on breast tissue, which can lead to breast cancer.
According to research, tamoxifen reduces the risk of developing breast cancer for BRCA1 and BRCA2 mutation carriers. Taking this drug, however, comes with a certain number of side effects.
Both pre and post-menopausal women can take advantage of Tamoxifen or its alternatives. When taken for 5 years, this medication reduces breast cancer incidences in high-risk women by 49%.
There are other selective estrogen receptor modulators available your doctor may recommend depending on your specific needs.
5. Healthy Lifestyle for Cancer Risk Reduction
Leading a healthy lifestyle is an integral part of any cancer risk prevention. Studies are currently being done to link a healthy lifestyle to risk prevention in BRCA-positive patients.
It’s important to rethink some of your current habits and make adjustments after consulting an oncologist. Typical lifestyle changes for BRCA-positive women and men include:
- Maintaining a healthy body weight
- Quitting smoking
- Opting for Mediterranean dietary patterns
- Getting necessary psychological support
- Exercising regularly
- Controlling stress levels
- Getting regular medical care
Making changes to your lifestyle choices may have a significant impact on your overall health.
Reducing Breast and Ovarian Cancer Risks for BRCA-Positive Patients
Testing positive for BRCA mutations is significant, but with today’s technologies, there are steps you can take to greatly reduce your risk of breast or ovarian cancer. Improved testing and a better understanding of breast cancer make this a better time than any to help preserve your health and bring some peace of mind.
If you have a history of breast cancer or ovarian cancer in your family and would like to discuss genetic testing, you can consult with our genetic counselors.
