The National Cancer Institute has advised that a woman’s risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful mutation in the BRCA1 gene or the BRCA2 gene. And men are susceptible as well. Men with these mutations also have an increased risk of breast cancer, and both men and women who have harmful BRCA1 or BRCA2 mutations may be at increased risk of additional types of cancer.
Grace Hou, M.D., a surgeon at the Breast Cancer Center of Excellence at Northwest Medical Center, noted that for women with the BRCA1 gene, the percentage of getting breast cancer by age 70 is 85 percent, and the rate of ovarian cancer exceeds 45 percent.
“For those with the BRCA2 gene, the figure is 80 percent for breast cancer, but it is more curable,” Hou pointed out.
BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins, according to the National Cancer Institute. These proteins help repair damaged DNA and help ensure the stability of the cell’s genetic material. When either of the genes is mutated, or altered, where its protein product either isn’t made or doesn’t function correctly, then DNA damage may not be repaired properly. Cells are more likely to develop more genetic alterations that can lead to cancer.
Specific inherited mutations BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and have been associated with increased risks of several additional types of cancer, the National Cancer Institute noted.
Genetic tests can check for BRCA1 and BRCA2 mutations in people with a family history of cancer that suggests the possible presence of a harmful mutation in one of these genes. If a harmful BRCA1 or BRCA2 mutation is found, several options are available to help a person manage their cancer risk.
“We test every 30-year-old for the BRCA gene,” Hou pointed out. “It’s important that if you have a family history of breast or ovarian cancer, you should make sure you do the test with a breast cancer specialist.”
Hou noted that a woman has a 50-50 chance of passing the gene on to her children.
“BRCA1 and BRCA2 have no symptoms, they are completely silent,” Hou says. “I’ve found that up to 10 percent of my breast cancer patients have this gene.”
Approximately 250,000 women in the United States are diagnosed with breast cancer every year, she added.
Carol Dehasse, M.D., an Ob/Gyn at Northwest Medical Center, concurred on the incidence of breast cancer susceptibility for the inherited gene.
“About 10 percent of all breast cancers are inherited types and 15 percent of ovarian cancers,” Dehasse said, “and of the inherited types, the majority are associated with the BRCA gene.”
Dehasse said her medical practice screens those patients who have a history of ovarian or breast cancer in their family.
“If it’s a high risk patient for BRCA, the lab will do the testing and insurance usually covers it,” she said. “If the person tests positive, there are certain guidelines we follow. We might recommend an ovary removal, or removal of the ovaries and Fallopian tubes.”
Dehasse pointed out that preventative surgery for those women with the BRCA gene has been found to help prevent all types of breast and ovarian cancers.
“It’s a difficult choice for women,” she said. “If a woman tests positive for the gene, if she doesn’t do surgery she may feel like she’s rolling the dice.”
Hou noted that once a woman is identified with the BRCA gene, she usually recommends that the ovarian cancer risk be addressed first.
“There is no screening test that is very accurate for ovarian cancer,” she said. “We want to take out the ovaries before age 40 because if we remove the ovaries premenopausal, it decreases the risk of breast cancer by 40 to 50 percent.”
Most patients with the BRCA gene mutation who choose surgery opt for a bilateral mastectomy, Hou said.
“A bilateral mastectomy takes away 94 percent of the breast cancer risk and 99 percent of the ovarian cancer risk,” Hou said. “If a patient doesn’t choose the surgery, we monitor them very closely, with a pelvic ultrasound and breast MRI (magnetic resonance imaging) and mammogram every year.”
Hou added that most women who undergo prophylactic breast surgery choose breast reconstruction when having a double mastectomy.
“Women are much happier to have reconstruction done at the same time,” she said. “We do immediate reconstruction because most women choose to do so.”