Risk Management
Breast and ovarian cancer risks
Overview
Cancer is a complex disease with many contributing causes, including hereditary factors. Women with a BRCA mutation have an elevated risk for breast and/or ovarian cancer. Some women who have a personal or family history indicative of a hereditary cancer syndrome who have not tested positive for a BRCA mutation may still have an elevated risk for these cancers. Experts use research on families with hereditary cancer to estimate the risk in people with BRCA mutations. Not all research has shown the same lifetime risk for cancer, even in two people with the same mutation. There are many reasons why risks for breast and ovarian cancer may differ. Varying factors such as environment, reproductive history, exercise level and body weight may effect who develops cancer and at what age. Many people base their risk-management decisions on their level of risk; a difference between a lifetime risk for breast cancer of 85% vs. 45% may alter their risk-management choices. Unfortunately, it is difficult to calculate a person’s exact risk of developing cancer in her lifetime. Nor can experts predict at what age someone might develop cancer.
Because of this uncertainty, most experts calculate an estimated “risk range” rather than a specific percentage when citing cancer risks related to a BRCA mutation or a strong family history of cancer. As researchers learn more about hereditary cancers, our understanding about why some people develop cancer at a younger age will improve, and so will our ability to assess cancer risk more accurately. To determine your risk for cancer and identify your risk management options, consult with experts in cancer genetics. They will provide the most current personalized information about cancer risk and management.
Breast cancer
Every woman is at risk for breast cancer and her risk increases with age. A woman in the general population faces about a 13% lifetime risk of developing breast cancer. This risk remains low before age 50; the majority of risk occurs after age 60. Women with a BRCA1 or BRCA2 mutation have a much higher lifetime risk for breast cancer, and much of the risk occurs at a younger age. However, experts don’t agree on the exact lifetime risk figures for women with either mutation because different studies of families with BRCA mutations identified different lifetime risks.
An October 2003 study of women carrying one of the three BRCA1 or BRCA2 mutations common in Jewish populations indicated a lifetime breast cancer risk of about 85%. This poster shows a decade-by-decade breakdown for breast cancer risk in BRCA carriers compared to the general population according to this study. The same study found BRCA mutation carriers born after 1940 have a higher lifetime risk for breast cancer than women born before 1940. Factors including lifestyle (diet, weight, and exercise), reproductive choices (number of pregnancies and age at the time of pregnancies) and exposure to certain viruses or chemicals may account for these differences. Different research involving many families with BRCA mutations (not specifically Jewish families) showed a comparatively lower breast cancer risk in women with BRCA mutations: 65% by age 70 for women with a BRCA1 mutation and 45% by age 70 for women with a BRCA2 mutation.
Women with BRCA mutations who have no family history of breast cancer are still at increased risk for the disease. Their risk is believed to be comparable to families with a history of breast cancer and the same mutation.
Predicting breast cancer risk is even more difficult in families with a strong history of breast or ovarian cancer but no BRCA mutation. It is important for women in these families to consult with a cancer genetics expert. Researchers are looking for other hereditary cancer causes in these families. Visit our page on research to determine whether your family qualifies for a study to identify cancer risk.
Confronting your personal cancer risk can be confusing and frustrating. If you are a high-risk woman trying to choose the best risk-management option, you need as much information about your personal risk as possible. Sometimes it helps to speak with other women who have faced these choices. Learn more about talking with other high-risk women in our support section of the website. As new research continues, the ability of medical experts to predict breast cancer risk will improve. Therefore it is important to consult with a specialist in cancer genetics when determining your risk for breast cancer and making risk-management decisions that are best for you. Stay in contact with a genetics expert for updates on current knowledge.
Risk for a second breast cancer
Women with a BRCA mutation, who choose breast conservation to treat their breast cancer are at higher risk for another cancer in either breast than a woman with sporadic breast cancer. Although exact risk depends on a woman’s age and other factors, one study found BRCA carriers diagnosed with breast cancer have a 14% chance within ten years of developing the disease in the same breast, and a 37% chance within ten years of developing the disease in the opposite breast. Another study found a 40% chance for BRCA carriers to develop cancer in the opposite breast as well within 10 years of their initial diagnosis. The risk for a second breast cancer among women who develop sporadic cancer is about 10%.
Ovarian cancer
Every woman is at some risk for ovarian cancer and her risk increases with age. The lifetime risk for ovarian cancer for the female general population is about 1.5%. That risk is much higher and occurs at a slightly younger age for women with BRCA1 or BRCA2 mutations. Experts don’t agree on the exact lifetime risk figures for women with either mutation because different studies on families with BRCA mutations have shown different lifetime risks for ovarian cancer. An October 2003 study of women with one of the three BRCA1 or BRCA2 mutations common in Jewish populations indicated a lifetime ovarian cancer risk of 54% in women with BRCA1 mutations and 23% in women with BRCA2 mutations. This poster shows the study’s decade-by-decade breakdown for ovarian cancer risk in BRCA carriers compared to the general population. A different study of multiple families with BRCA mutations (not specifically Jewish families) found a comparatively lower risk: 39% for BRCA1 carriers, compared to 11% of BRCA2 carriers by age 70. Both studies show the risk for ovarian cancer in BRCA carriers begins after the age 30, and most of the risk occurs after age 40. A recent study suggests that much of the ovarian cancer in BRCA carriers may begin in the fallopian tubes. See our section on fallopian tube cancer and our section on prophylactic oophorectomy for more information on fallopian tube cancer.
Women with BRCA mutations but with no family history of ovarian cancer are still at increased risk for the disease. Their risk is believed to be comparable to other families with the same mutation and a history of ovarian cancer.
Predicting ovarian cancer risk is even more difficult in families with a strong history of breast or ovarian cancer but no BRCA mutation. It is important for women in these families to consult with a cancer genetics expert. Researchers are looking for other hereditary cancer causes in these families. Visit our page on research to determine whether your family qualifies for a study to identify cancer risk.
Confronting your personal risk can be confusing and frustrating. If you are a high-risk woman trying to choose the best risk-management option, you need as much information about your personal risk as possible. Sometimes it helps to speak with other women who have faced these choices. Learn more about talking with other high-risk women in our support section of the website. As new research continues, the ability of medical experts to predict ovarian cancer risk will improve. Therefore it is important to consult with a specialist in cancer genetics when determining your risk for ovarian cancer and making risk-management decisions that are best for you. Stay in contact with a genetics expert for updates on current knowledge.
Ovarian cancer risk after breast cancer
Breast cancer survivors who have a BRCA mutation or hereditary breast cancer are at higher risk for ovarian cancer than breast cancer survivors with sporadic breast cancer. A research study on ovarian cancer risk in breast cancer survivors with a BRCA mutation found a 12.7% risk in BRCA1 carriers and 6.8% risk in BRCA2 carriers within 10 years of the breast cancer diagnosis.
Women with a family history of breast and ovarian cancer but no identified BRCA mutation have an elevated risk of ovarian cancer after breast cancer, but the exact risk is unknown. For women with breast cancer who have a family history of breast cancer only, (no ovarian cancer in the family) but no known mutation, the risk for ovarian cancer may not be elevated above the risk for the general population. One study on women from families with an extensive history of breast cancer but without a BRCA mutation found the risk for ovarian cancer was no higher than for women in the general population.
Genetics experts can help breast cancer survivors who have a BRCA mutation, a family history of cancer, or other indicators of hereditary cancer determine their risk for ovarian cancer and develop a risk management plan.
Breast cancer risk after ovarian cancer
Ovarian cancer survivors who have a BRCA mutation are at higher risk for breast cancer than women with sporadic ovarian cancer. The exact risk for breast cancer after ovarian cancer is unknown, but may depend on a number of factors. Genetic experts can help ovarian cancer survivors with a BRCA mutation, a family history of cancer, or other indicators of hereditary cancer determine their risk for breast cancer and develop a risk management plan.
Male breast cancer
Anyone, male or female can get breast cancer, but generally, men are much less likely to develop the disease than women. Men who carry a BRCA mutation have a higher risk for breast cancer than men in the general population. However, the risk is still fairly low. Several small studies have determined the lifetime risk for breast cancer to be about 6% in men with BRCA1 mutations and about 7% in men with BRCA2 mutations.
Sexual Orientation as a Risk Factor
Definitive research on the incidence of cancer in lesbians has yet to be conducted and the results so far have been somewhat contradictory. However, there is a body of evidence suggesting that lesbians have a dense cluster of risk factors, significantly raising their risk of developing breast, ovarian and other cancers. Research shows, for example, that lesbians have higher rates of obesity and lower rates of childbearing before age 30, increasing the risks for both breast and ovarian cancer. Unfortunately, increased risks are coupled with lower cancer screening rates for this population, resulting in cancers being detected at a later stage when they are more difficult to treat. The most cited reasons for delaying or avoiding cancer screenings are cost (access to care) and feared or past discrimination by the health care system. In fact, provider bias against lesbians has been well documented. This information was provided by the National LGBT Cancer Network.
Other websites
National
Comprehensive Cancer Network
This consortium of experts in the field of oncology publishes a consensus
guides for various aspects of risk management for high-risk women.
Women’s
Cancer Network
A good overview of the risks factors for ovarian cancer.
The Gay and Lesbian Medical Association, Cancer in Our Lives
American Cancer Society
Cancer Facts for Gay, Lesbian and Bisexual
Men and Women
Mautner Project, The National Lesbian Health Organization
Further reading - books/booklets
Management of Patients at High-Risk for Breast Cancer, by Victor G. Vogel, MD
Understanding Your Risk of Ovarian Cancer
This brochure developed by the Gynecologic Cancer Foundation and sponsored by Project Hope outlines the symptoms, risks, screening, and prevention of ovarian cancer in a concise, easy-to-read format.
Further reading - articles (advanced reading)
Primary
Fallopian Tube Malignancies in BRCA-Positive Women Undergoing Surgery for
Ovarian Cancer Risk Reduction
Michael J. Callahan, Christopher P. Crum,
Fabiola Medeiros, David W. Kindelberger, Julia A. Elvin, Judy E. Garber,
Colleen M. Feltmate, Ross S. Berkowitz, Michael G. Muto. Journal
of Clinical Oncology. Volume 25, No. 25: p. 3985-3990, September 2007.
The
risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers
Metcalfe
KA, Lynch HT, Ghadirian P, Tung N, Olivotto IA, Foulkes WD, Warner E, Olopade
O, Eisen A, Weber B, McLennan J, Sun P, Narod SA. Gynecologic
Oncology.
Volume 96, Issue 1, January 2005: p. 222-226. (Pubmed abstract)
Risk of Ovarian Cancer in BRCA1 and BRCA2 Mutation-Negative Hereditary Breast Cancer Families
Noah D. Kauff, Nandita Mitra, Mark E. Robson, Karen E. Hurley, Shaokun Chuai, Deborah Goldfrank, Eve Wadsworth, Johanna Lee, Tessa Cigler, Patrick I. Borgen, Larry Norton, Richard R. Barakat, Kenneth Offit.
Journal of the National Cancer Institute. Volume 97, issue 18: p. 1382-1384, September 2005.
Appropriateness
of breast-conserving treatment of breast carcinoma in women with germline
mutations in BRCA1 or BRCA2
Mark Robson, M.D., Tiffany Svahn, M.D.,
Beryl McCormick, M.D., Patrick Borgen, M.D., Clifford A.Hudis, M.D., Larry
Norton, M.D., Kenneth Offit, M.D., M.P.H. Cancer. Volume 103, Issue 1:
p. 44 - 51, January 2005.
Breast-feeding
and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers
Jernstrom,
H, Lubinski, J., Lynch, P., et al. Journal of
the National Cancer Institute.
Volume 96, No. 14, 1094-1098. July 21, 2004.
Contralateral breast
cancer in BRCA1 and BRCA2 mutation carriers
Kelly Metcalfe, Henry T.
Lynch, Parviz Ghadirian, Nadine Tung, Ivo Olivotto, Ellen Warner, Olufunmilayo
I. Olopade, Andrea Eisen, Barbara Weber, Jane McLennan, Ping Sun, William
D. Foulkes, Steven A. Narod. Journal of Clinical
Oncology. Volume 22, Number
12: p. 2328-2335, June 2004.
Smoking
and the risk of breast cancer among carriers of BRCA mutations
Parviz
Ghadirian, Jan Lubinski , Henry Lynch , Susan L. Neuhausen , Barbara Weber
, Claudine Isaacs , Ruth-Gershoni Baruch, Susan Randall, Peter Ainsworth,
Eitan Freidman, Douglas Horsman, Patricia Tonin, William D. Foulkes, Nadine
Tung, Ping Sun, Steven A. Narod. International
Journal of Cancer. Volume
110, Issue 3 , p. 413-416, June 2004.
Breast
and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2
King
MC, Marks JH, Mandell JB; New York Breast Cancer Study Group. Science.
Volume 24, p. 643-6, October 2003. (Pubmed abstract)
BRCA1 and p53: Compensatory
roles in DNA repair
Anne-Renee Hartman and James M. Ford. Journal
of Molecular Medicine. September 9, 2003. (A literature review)
BRCA2 mutation
carriers, reproductive factors and breast cancer risk
Laufey Tryggvadottir,
Elinborg J Olafsdottir, Sigfridur Gudlaugsdottir, Steinunn Thorlacius,
Jon G Jonasson, Hrafn Tulinius and Jorunn E Eyfjord. Breast
Cancer Research.
Volume 5: p.121-128, June 2003.
Prevalence of BRCA1
and BRCA2 germline mutations in young breast cancer patients: A population-based
study
Silvia de Sanjosé, Mélanie Léoné,
Victoria Bérez, Angel Izquierdo, Rebeca Font, Joan M. Brunet, Thierry
Louat, Loreto Vilardell, Joan Borras, Pau Viladiu, F. Xavier Bosch, Gilbert
M. Lenoir, Olga M. Sinilnikova. International
Journal of Cancer. Volume
106, Number 4, p. 588-593, June 2003.
Reproductive
factors and ovarian cancer risk in Jewish BRCA1 and BRCA2 mutation carriers
(United States)
Modugno F, Moslehi R, Ness RB, Nelson DB, Belle S,
Kant JA, Wheeler JE, Wonderlick A, Fishman D, Karlan B, Risch H, Cramer
DW, Dube MP, Narod SA. Cancer Causes Control. Volume 5: p. 439-46, June
2003. (Pubmed abstract)
Average
risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations
detected in case series unselected for family history: A combined analysis
of 22 studies
A. Antoniou, P. D. P. Pharoah, S. Narod, H. A. Risch,
J. E. Eyfjord, J. L. Hopper, N. Loman, H. Olsson, O. Johannsson, Å.
Borg, B. Pasini, P. Radice, S. Manoukian, D. M. Eccles, N. Tang, E. Olah,
H. Anton-Culver, E. Warner, J. Lubinski, J. Gronwald, B. Gorski, H. Tulinius,
S. Thorlacius, H. Eerola, H. Nevanlinna, K. Syrjäkoski, O.-P. Kallioniemi,
D. Thompson, C. Evans, J. Peto, F. Lalloo, D. G. Evans, and D. F. Easton.
American Journal of Human Genetics. Volume 72: p. 1117-1130, May 2003.
Ovarian
cancer risk in Ashkenazi Jewish carriers of BRCA1 and BRCA2 mutations
Jaya
M. Satagopan, Jeff Boyd, Noah D. Kauff, Mark Robson, Lauren Scheuer, Steven
Narod and Kenneth Offit. Clinical Cancer Research. Volume 8: p. 3776-3781,
December 2002.
Cancer
risk estimates for BRCA1 mutation carriers identified in a risk evaluation
program
Marcia S. Brose, Timothy R. Rebbeck, Kathleen A. Calzone, Jill
E. Stopfer, Katherine L. Nathanson, Barbara L. Weber. Journal
of the National Cancer Institute. Volume 94, Number 18: p. 1365-1372, September 18, 2002.
On
the use of familial aggregation in population-based case probands for calculating
penetrance
Colin B. Begg. Journal of the National Cancer
Institute.
Vol. 94, Number 16: p. 1221-1226, August 21, 2002. (Note: a commentary on
this article is available in the same issue of JNCI.)
Clinical characteristics
of individuals with germline mutations in BRCA1 and BRCA2: Analysis of
10,000 individuals
Thomas S. Frank, Amie M. Deffenbaugh, Julia E. Reid,
Mark Hulick, Brian E. Ward, Beth Lingenfelter, Kathi L. Gumpper, Thomas
Scholl, Sean V. Tavtigian, Dmitry R. Pruss, Gregory C. Critchfield. Journal
of Clinical Oncology. Volume 20, Issue 6: p. 1480-1490, March 2002.
Modification
of BRCA1- and BRCA2: associated breast cancer risk by AIB1 genotypeand
reproductive history
Timothy R. Rebbeck, Yiting Wang, Philip W. Kantoff,
Krishna Krithivas, Susan L. Neuhausen, Andrew K. Godwin, Mary B. Daly,Steven
A. Narod, Jean-Sebastian Brunet, Daniel Vesprini, Judy E. Garber, Henry
T. Lynch, Barbara L. Weber and Myles Brown. Cancer
Research. Volume 61:
p. 5420-5424, July 2001.
The lifetime
risks of breast cancer in Ashkenazi Jewish carriers of BRCA1 and BRCA2
mutations
Jaya M. Satagopan, Kenneth Offit, William Foulkes, Mark E.
Robson, Sholom Wacholder, Christine M. Eng, Stephen E. Karp and Colin B.
Begg. Cancer Epidemiology Biomarkers & Prevention. Volume 10: p. 467-473,
May 2001. (Full text)
Genetic
heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast
cancer families
D. Ford, D. F. Easton, M. Stratton, S. Narod, D. Goldgar,
P. Devilee, D. T. Bishop, B. Weber, G. Lenoir, J. Chang-Claude, H. Sobol,
M. D. Teare, J. Struewing, A. Arason, S. Scherneck, J. Peto, T. R. Rebbeck,
P. Tonin, S. Neuhausen, R. Barkardottir, J. Eyfjord, H. Lynch, B. A. J.
Ponder, S. A. Gayther, J. M. Birch, A. Lindblom, D. Stoppa-Lyonnet, Y.
Bignon, A. Borg, U. Hamann, N. Haites, R. J. Scott, C. M. Maugard, H. Vasen,
S. Seitz, L. A. Cannon-Albright, A. Schofield, M. Zelada-Hedman, and the
Breast Cancer Linkage Consortium. American Journal
of Human Genetics. Volume
62: p: 676-689, March 1998.
The
Risk of cancer associated with specific mutations of BRCA1 and BRCA2 among
Ashkenazi Jews
Jeffery P. Struewing, M.D., Patricia Hartge, Sc.D.,
Sholom Wacholder, Ph.D., Sonya M. Baker, B.S., Martha Berlin, B.A., Mary
McAdams, M.S., Michelle M. Timmerman, B.S., Lawrence C. Brody, Ph.D., and
Margaret A. Tucker, M.D. New England Journal
of Medicine. Volume 336, Number
20: p. 1401-1408, May 1997.
The
genetic attributable risk of breast and ovarian cancer
Claus EB, Schildkraut
JM, Thompson WD, Risch NJ. Cancer. Volume 77, Number 11: p. 2318-2324,
June 1996.