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.
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.
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%.
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.
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.
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.
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.
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.
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
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.
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
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The
risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers
Metcalfe
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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
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Breast-feeding
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Contralateral breast
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Smoking
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, Claudine Isaacs , Ruth-Gershoni Baruch, Susan Randall, Peter Ainsworth,
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Breast
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MC, Marks JH, Mandell JB; New York Breast Cancer Study Group. Science.
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BRCA1 and p53: Compensatory
roles in DNA repair
Anne-Renee Hartman and James M. Ford. Journal
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BRCA2 mutation
carriers, reproductive factors and breast cancer risk
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Elinborg J Olafsdottir, Sigfridur Gudlaugsdottir, Steinunn Thorlacius,
Jon G Jonasson, Hrafn Tulinius and Jorunn E Eyfjord. Breast
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M. Lenoir, Olga M. Sinilnikova. International
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