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Reducing Cancer Risk When You Are BRCA-Positive

Overview

BRCA1 and BRCA2 are genes that normally help control cell growth. But an inherited change, called a mutation, in one of these genes makes you much more likely to get breast, ovarian, and some other cancers. BRCA (say "BRAH-kuh") stands for "BReast CAncer."

BRCA gene changes aren't common. Your doctor may talk to you about testing based on your family medical history or your personal medical history. Your doctor may ask you questions, such as if you have family members who had breast or ovarian cancer, if you were diagnosed with breast cancer before age 50, or if you have an Ashkenazi Jewish heritage.

If you are concerned that you may have a BRCA gene change, talk with your doctor.

In the table below, the figures are only rough estimates from research studies of females. These numbers may not apply to you, but they can give you an idea of how high your risk may be.footnote 1

How does having a BRCA gene change affect your risk?

Breast cancer risk

Ovarian cancer risk

Females without a BRCA gene change

About 13 out of 100 will get breast cancer sometime during their lives.

About 1 out of 100 will get ovarian cancer sometime during their lives.

Those with BRCA1 gene

About 72 out of 100 will get breast cancer by age 80.

About 44 out of 100 will get ovarian cancer by age 80.

Those with BRCA2 gene

About 69 out of 100 will get breast cancer by age 80.

About 17 out of 100 will get ovarian cancer by age 80.

Pictures may help you get a better idea of how much a BRCA gene change increases your risk for breast cancer and ovarian cancer.

Genetic testing can show if you have gene changes that increase your risk for breast cancer and ovarian cancer. Before you have genetic testing, you may want to see a genetic counselor. Counseling will help you decide about genetic testing. Both testing and counseling are often covered by insurance. But check with your insurance company to find out for sure.

Ways to reduce cancer risk

Experts know that people who are BRCA-positive are more likely to get breast cancer and ovarian cancer. If you are BRCA-positive, you can take steps to reduce your risk of these cancers.

To help those with BRCA changes, experts did a study of women with BRCA changes to predict how much breast and ovarian cancer risk could be reduced by certain methods. These methods include:

  • 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 results of the study are shown in the tables below.

The study also looked at having the surgeries at different ages. For example, you can see what difference it might make if you keep your breasts and ovaries until you're past your childbearing years. These results are one piece of information you can use as you explore how to lower your cancer risk.

Surgery and screening tests are not your only options. You can also talk to your doctor about medicines, such as tamoxifen. Or you may 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 those with BRCA1 changes. footnote 2

Comparing prevention methods for women with BRCA1 changes

Prevention method

Those 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 those with BRCA2 changes. footnote 2

Comparing prevention methods for women with BRCA2 changes

Prevention method

Those 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

Deciding about your options

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.

References

Citations

  1. Kuchenbaecker KB, et al. (2017). Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA, 317(23): 2402–2416. DOI: 10.1001/jama.2017.7112. Accessed August 5, 2020.
  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.

Credits

Current as of: November 22, 2021

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Wendy Y. Chen MD, MPH - Medical Oncology, Hematology