Managing Risk for Hereditary Breast, Ovarian, and Related Cancers

Overview

Medical options are available to manage breast, ovarian, prostate, and pancreatic cancer risk in people who have breast cancer (BRCA1 or BRCA2) gene mutations, but who have not had cancer. Discuss the possible risks and benefits with a doctor knowledgeable about medical management for people with BRCA gene mutations.

Breast and ovarian cancers

Women

Women with BRCA gene mutations are more likely to get breast and ovarian cancer than other women.

The most effective way to prevent breast and ovarian cancer in women with BRCA gene mutations is surgery to remove the breasts (mastectomy) and surgery to remove the ovaries and fallopian tubes (salpingo-oophorectomy).

Other options may lower the chance of getting cancer or increase the chance of finding it early, but the effectiveness of these options is less certain. Some options are:

• Taking medications (such as tamoxifen, raloxifene, and aromatase inhibitors) to lower the chance of getting breast or ovarian cancer.
• Yearly screening with breast magnetic resonance imaging (MRI) and mammogram, starting at a younger age than most women.
• Clinical breast exams.
• Screening for ovarian cancer with transvaginal ultrasound and CA-125 blood tests.
• Engaging in healthy behaviors, such as keeping a healthy weight and being physically active.
• Paying attention to how your breasts normally look and feel and letting your doctor know right away if you notice any changes.

Genetic testing can also guide treatment options for women with breast or ovarian cancer to prevent future cancers. For example, women with cancer in one breast who test positive for a BRCA gene mutation may choose to have both breasts removed, rather than having surgery only on the affected breast.

Men

Men with BRCA gene mutations are more likely to get breast cancer than other men. If you are a man with a BRCA gene mutation, your doctor may recommend:

• Breast self-exam training and education starting at age 35.
• Yearly clinical breast exams starting at age 35.
• Yearly mammograms starting at age 50, or 10 years younger than the earliest known male breast cancer in the family, whichever is younger.

Prostate cancer

Men with BRCA gene mutations are more likely to get high-grade prostate cancer than other men. If you are a man with a BRCA gene mutation, your doctor may recommend prostate cancer screening starting at age 40, especially for men with a BRCA2 gene mutation.

Pancreatic cancer

Both men and women with BRCA gene mutations are more likely to get pancreatic cancer. If you have a BRCA gene mutation and a close relative with pancreatic cancer, your doctor may recommend screening for pancreatic cancer starting at age 50, or 10 years younger than the earliest known pancreatic cancer in your family, whichever is younger.

Trusting Your Doctor

Learning that you have a BRCA gene mutation can take an emotional toll. Finding a doctor she trusted empowered Allison to face her risk and be proactive about her health.