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Thursday, July 31, 2014
Reducing Risk of Breast Cancer
I recently tested positive for the BRAC 2 mutation. Was diagnosed with Stage 3C ovarian cancer 9/2005. Had a recurrence 8/2007 and have been on Doxil since that time. Any thoughts regarding appropriate action to take for my breast cancer risk? Thanks so much.
As your question indicates, women who have mutations in the gene named BRCA2 have an increased risk for both ovarian cancer and breast cancer. The lifetime risk for breast cancer is estimated in various sources to be as high as 50-85%, and the risk for ovarian cancer is estimated to be as high as 15-27%. Not every women who inherits a BRCA2 mutation will necessarily develop cancer, but each of her children will have a 50% chance to inherit the mutation.
As for managing your breast cancer risk, you should talk with your doctors and ask for a referral to a high risk breast specialist. This will typically be a breast surgeon. Options that you may discuss include more intensive breast cancer screening (more frequent or new, more sensitive screening options), taking medications to reduce the risk for breast cancer, and consideration of removing your breasts before cancer is diagnosed. There are benefits, risks and limitations to each option, and these should be discussed with your breast specialist. Your doctors will take into account your past and current treatments, how high your concern is about the chance of developing breast cancer, and which options are most acceptable to you. There is no single right answer; the best plan is one that addresses your concerns about cancer risk, and your view of the impact of each option on your life.
Typically, one should meet with a genetic counselor or a medical geneticist before and after genetic testing is done to discuss the chance of developing various cancers if one has the mutation, options to improve early detection or to reduce cancer risk, and the implications for other members of the family. However, it sounds like you may not have done this. You may still wish to schedule an appointment to review the implications of having a BRCA2 mutation and ways to address cancer risk. You can talk with your physicians about a referral to a genetic counselor or medical geneticist in your area, or you can locate a genetic counselor by using the website listed below for the National Society of Genetic Counselors.
Duane D Culler, PhD, MS
Clinical Instructor of Genetics
School of Medicine
Case Western Reserve University