Every October we celebrate Breast Cancer Awareness month, a chance to celebrate survivors, mourn loved ones, encourage those who are still fighting and raise overall awareness of the disease. While it is well known that mammograms and self-exams are the best ways to detect breast cancer early, women have become more aware of genetic risks that can make breast cancer a bigger risk than usual.
BRCA genes are probably the most talked-about genes linked to an increased risk of breast cancer, especially after actress Angelina Jolie brought awareness to the risks posed by being a carrier of those genes, which can be passed from parent to child. Soon, more and more celebrities started coming forward with stories about preventative measures they had taken.
The United States Preventive Services Task Force currently recommends that women who have family members with breast, ovarian, fallopian tube, or peritoneal cancer be evaluated to see if they have a family history that is associated with an increased risk of a harmful mutation in one of these genes
But how do you know if you have a genetic mutation like one of the BRCA mutations? We talked to two breast surgeons to get an explanation of how BRCA mutations are diagnosed and what treatment options are available.
Genetic testing and family history is the first step, says Radha Iyengar, M.D., a breast surgeon and physician on the medical staff at Texas Health Allen and at Breast Surgery Center of North Texas, a Texas Health Physicians Group practice.
“The only way to know for sure is to have genetic testing done,” she says, adding that people who have the mutation often have a significant family history of breast cancer and/or ovarian cancer.
“This is done with a simple blood or saliva test in a doctor’s or a genetic counselor’s office,” she says.
So, if the testing reveals you do have a mutation, does it mean that you’ll most certainly develop breast cancer? Jones says that each mutation has its own risk range.
“If you test positive for BRCA1, you have a 40–85 percent lifetime risk of developing breast cancer and a 16–44 percent lifetime risk of developing ovarian cancer,” Jones adds. “If you test positive for BRCA2, women have a 40-85 percent lifetime risk for breast cancer and a 16–27 percent lifetime risk for ovarian cancer.”
And it’s not just something that affects women. Men are at risk with BRCA2 as well, Jones cautions.
“If a man tests positive, he may have a 7–8 percent lifetime risk of developing breast cancer and a 20 percent lifetime risk of developing prostate cancer,” Jones explains. “There are also other genetic mutations associated with an increased risk of developing breast cancer for which we can test a person.”
Many are familiar with Angelina Jolie’s decision to have a double mastectomy after discovering she was genetically predisposed to developing breast cancer. But is that the only course of treatment?
Both surgeons agree that it depends on your family history.
“I would not say this was a drastic course, but it is a decision best made with your physician and after speaking to a genetic counselor,” Jones agrees. “If you look at the percentages, the risks are real and a double mastectomy can significantly reduce the risk.
“However, there are some women who have contraindications to surgery, are still hoping to have children and breastfeed, or simply do not want their breasts removed,” she adds.
In that case, your medical team will have recommendations to keep a watchful eye on your health.
“We do recommend that patients who choose to keep their breast tissue undergo more stringent screenings—more than just a yearly mammogram,” Iyengar explains.
Those more stringent screenings, Jones says, include alternating mammograms and breast MRIs every six months.
Talking to your doctor about these potential risk factors can determine if you or other family members need to consider genetic testing.
But before you panic, the NCI says these genetic mutations are actually fairly rare. For most women, regular self-exams, a baseline mammogram between 35 and 40 years old, and yearly mammograms after 40 are the best means of early detection.
Are you an employer or part of a group that would like to make mammograms even more convenient? Contact the Mobile Health Unit by calling 817-250-1910 or emailing THRMobileUnit@texashealth.org to get more information.