June 3, 2021
5 Ways to Reduce Your Breast and Ovarian Cancer Risk When You're BRCA Positive
You may have been tested for the BRCA gene mutation and discovered that you have a positive result. While this news may come as a surprise to you or have you evaluating your next steps, there are some actions you can take now that can reduce your risk of developing breast cancer or ovarian cancer. If you’re not familiar with the BRCA gene mutation, read more about it in our
Keep in mind, the risk reduction options listed here range in seriousness and may not be the best solution for everybody. It's important you evaluate your choices carefully and move forward with the risk-reducing options that you, your doctor, and your partner are most comfortable with.
Cancer Risk-Reducing Options to Consider After Testing Positive for a BRCA gene mutation
If you test BRCA-positive, your doctor may discuss one or more of the following options with you:
More frequent cancer screening
Breast removal surgery (mastectomy)
Ovary removal surgery (oophorectomy)
Healthy lifestyle choices
It's important to note that if you are BRCA-positive, then you have up to a six times greater risk for developing breast or ovarian cancer during your lifetime. That’s why it’s important to at least understand your options for reducing the risk of developing these types of cancer.
1. More Frequent Breast Cancer and Ovarian Cancer Screening
As with any cancer, early detection makes all of the difference. The sooner you find out that you have cancer, the sooner that treatment plans can be put in place. Screening tests are designed to find cancer as early as possible.
- Breast cancer screening for men and women who are BRCA-positive
While doctors recommend starting annual breast cancer screening at the age of 40 for people of average risk, BRCA-positive women can start regular mammograms as early as age 25. Regardless of your age, when you get 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 that 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 start self-exams at 35. Mammograms are typically not offered to men, especially due to the limited amount of breast tissue.
Ovarian Cancer Screening for BRCA-positive women
While there are no ovarian cancer screening tests for those who are at average risk, there are some options available for those at higher risk.
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.
Be sure you tell your gynecologist that you are BRCA positive. In most cases they will suggest a clinical pelvic exam at least once a year starting at age 25, looking for any lumps or signs of tumors
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.
Your doctor can explain which screening methods are most appropriate for you based on your lifestyle and other health factors.
2. Preventive Mastectomy
Some women may consider surgically removing both breasts to prevent breast cancer development. Opting for preventive (also called prophylactic) mastectomy is a serious decision that may or may not be the best option for you.
When considering such a surgery, you, and your partner, should discuss it with your doctor and the breast surgeon to understand options, recovery, and what life would be like after the surgery. You should also talk about options for rebuilding the breasts whether with your own tissue or with implants. Reconstruction can be immediate or you can wait until you’ve healed from one surgery. Your surgeon will make their best recommendation based on your personal health history.
It's important to note that preventive mastectomy does not completely eliminate the risk of developing breast cancer.
For women who tested positive for BRCA1 and BRCA2 mutations, 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 preventative mastectomy.
3. Preventive 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. This is because the ovaries produce estrogen which can fuel some types of breast cancer as well as ovarian cancer.
Experts also recommend that women with BRCA1 mutations remove fallopian tubes along with ovaries (bilateral salpingo-oophorectomy) if they are done having children.
Just as with mastectomy, oophorectomy doesn't offer 100% breast or ovarian cancer prevention.
In post-menopausal women, preventive 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. Because of this timeline, your doctor may suggest that you complete your family by the age of 40.
Chemoprevention, or using medications to prevent cancer, is another option for some people who test BRCA positive. The treatment is highly individual and must be discussed with an oncologist. Keep in mind; these medications can also come with side effects that you'll want to be aware of before moving forward.
Selective Estrogen Receptor Modulators
Tamoxifen is a Selective Estrogen Receptor Modulator (SERM). It blocks the effect 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 comes with a certain number of side effects, including, but not limited to, hot flashes, vaginal discharge, joint or muscle pain, and feelings of depression. Talk with your doctor to learn the full set of side effects that you could experience while taking this medication.
Both pre-and post-menopausal women can take advantage of Tamoxifen or its alternatives. When taken for five years, this medication reduces breast cancer incidence in high-risk women by 49%.Your doctor may also discuss other options for medication based on various health factors.
5. Healthy Lifestyle for Cancer Risk Reduction
Leading a healthy lifestyle is a helpful part of any cancer risk prevention plan. Your doctor may suggest the following lifestyle changes to reduce your risk of developing breast or ovarian cancer:
Maintaining a healthy body weight through diet
Opting for Mediterranean dietary patterns
Controlling stress levels
Getting regular medical care including cancer screenings
Making these small changes could have significant impacts on your overall health.
Reducing Your Risk of Hereditary Breast and Ovarian Cancer
Learning that you are BRCA-positive can lead you to ask a lot of questions about your health. However, there are many risk-reducing options available. Talk with your doctor and/or your genetic counselor about your choices, and then take time to consider which, if any, you’re most comfortable implementing into your life. Doing so could help preserve your health and bring some peace of mind.
Categories: Breast Cancer