Here’s who may benefit (and who won’t).
Part of the fear of breast cancer is simply not knowing if you’ll be one of the 12 percent of U.S. women who develops breast cancer over her lifetime. Some people have turned to genetic testing for breast cancer, hoping it could give them answers before cancer cells possibly arrive.
Is Breast Cancer Genetic?
“There’s only a small percentage of breast cancers that are diagnosed that we actually believe are genetically linked,” says Brenda Panzera, MD, an oncologist at Lenox Hill and Mount Sinai Hospitals in New York City.
Like all risk factors for breast cancer, having certain genes does not cause breast cancer but instead can increases your risk. Genetic testing for breast cancer looks for gene mutations that are associated with breast cancer, namely the BRCA 1 gene and BRCA 2 gene.
The BRCA genes are associated with not only breast cancer, but also ovarian, fallopian tube, peritoneal, pancreatic, skin, and prostate cancers. While the average U.S. woman has a 12 percent chance of developing breast cancer, those with a BRCA gene mutation have a 45 to 65 percent chance, according to the Susan G. Komen Foundation.
Who Should Get Genetic Testing for Breast Cancer?
While genetic testing can’t tell you definitively whether you get have breast cancer in the future or not, it may be beneficial for some people. Knowing you have an increased risk of breast cancer can allow you to get screened more frequently and may help you recognize breast cancer symptoms more promptly. In some cases, women with very strong breast cancer risk factors may opt for preventive medication or surgery to further reduce their odds of getting breast cancer.
Doctors generally offer genetic testing for breast cancer to the following groups:
Women diagnosed with breast cancer under the age of 40
Women diagnosed with breast cancer and also have a first-degree relative with breast or ovarian cancer
Women who are diagnosed and are of Ashkenazi Jewish descent, in which the BRCA genes are more common
What Happens If You’re BRCA-Positive?
Since those with a BRCA gene mutation are at an increased risk, doctors will likely recommend more frequent screening.
“For women who are known to be BRCA-positive, we often will recommend that they have annual mammograms alternating with annual MRIs,” says Dr. Panzera, “so that they have breast imaging every six months.”
Clinical breast exams should also be done regularly throughout the year for women who test positively for the BRCA genes. While self-breast exams are a good tool, professionals may be more accurate and valuable for detecting breast cancer accurately.
Doctors also recommend regular ob-gyn exams for women with the BRCA genes, especially since this gene mutation increases the risk of ovarian and fallopian tube cancers.
“We sometimes discuss with patients who are known gene carriers the possibility of using … medications such as tamoxifen to decrease the risk of breast cancer,” says Dr. Panzera. Tamoxifen binds to estrogen receptors and blocks estrogen, according to the National Cancer Institute.
Another option is oral contraceptives, which has been linked to a lower risk of ovarian cancer. (Here are more things to know about the Pill.)
Beyond medication, women may choose to have prophylactic surgery—either a bilateral mastectomy to remove both breasts or a bilateral oophorectomy to remove the ovaries—before a cancer diagnosis. This greatly reduces the risk of cancer and may be an option for women with a very high risk of developing breast or ovarian cancer. (Learn more about the risk factors for breast cancer here.)
Genetic testing can never tell the whole story, but it can provide valuable information. Either way, it’s important to maintain regular appointments with your doctor. Find out what tests women need in their forties, and check out what tests women in their fifties need.
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There's only a small percentage of breast
cancers that are diagnosed that we
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actually believe are genetically linked.
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Most of the breast cancers that
are diagnosed are not linked to genetics.
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So there's a lot about breast
cancer that we don't know.
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Genetic testing is testing where they
will take an individual's blood or
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other tissues and analyze them for
mutations that we know
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have been associated with breast cancer,
or other cancers.
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The two most common genes associated
with breast cancer are the BRCA1 or
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BRCA2 genes, the BRCA genes.
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Those genes when identified
are associated with a significantly
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increased risk of breast cancer
over an individual's lifetime.
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Additionally, those particular genes
are also associated with an increased risk
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of other cancers, such as ovarian cancer,
Fallopian tube cancer, peritoneal cancer.
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Sometimes pancreatic cancer, skin cancer.
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And in men, sometimes prostate cancer.
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Genetic testing is usually offered to
women who are diagnosed with breast cancer
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under the age of 40 or women who
are diagnosed with breast cancer and
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have a first degree relative who is
also had breast, or ovarian cancer, or
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women who are diagnosed with breast cancer
and are of Ashkenazi Jewish descent.
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For women who are known
to be BRCA positive,
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we often will recommend that
they have annual mammograms.
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Alternating with annual MRIs, so that they
have breast imaging every six months.
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We will often recommend that they
see a healthcare provider for
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clinical breast examinations at
intervals throughout the year.
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We also recommend that they
see a gynecologist for
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interval gynecological examinations that
will involve screening for ovarian cancer.
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Additionally, we will often have
conversations about prevention.
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We sometimes discuss with patients who
are known gene carriers, the possibility
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of using either medications such as
tamoxifen to decrease the risk of breast
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cancer though, the data in this particular
group of patients is not very robust.
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We will also sometimes even discuss
the possibility of using oral
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contraceptives to decrease
the incidents of ovarian cancer and
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then we have prophylactic surgeries
that we will often discuss,
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which could include a bilateral
prophylactic mastectomy which greatly
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reduce the incidents or
risk of developing breast cancer.
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Additionally, we will often
discuss the possibility
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of having a bilateral oophorectomy
which refers to removing the ovaries
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which greatly reduces the risk
of developing ovarian cancer.
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Ashkenazi Jewish heritage. Susan G. Komen Foundation. (Accessed on May 21, 2018 at https://ww5.komen.org/BreastCancer/AshkenaziJewishHeritage.html.)
Hormone therapy for breast cancer. Bethesda, MD: National Cancer Institute. (Accessed on May 21, 2018 at https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet.)
Surgery to reduce the risk of breast cancer. Bethesda, MD: National Cancer Institute. (Accessed on May 21, 2018 at https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet.)
U.S. breast cancer statistics. Ardmore, PA: Breastcancer.org. (Accessed on May 21, 2018 at http://www.breastcancer.org/symptoms/understand_bc/statistics.)