- How can I manage my increased risk of breast cancer?
- What are the implications for my treatment for ovarian cancer?
Your genetic counsellor will discuss with you the different ways of reducing your risk of developing breast cancer. There are three options to consider - screening, risk reducing surgery and drug treatment. The choice will take into account your current health and the prognosis of your diagnosis of ovarian cancer.
The NHS runs a breast screening programme for women throughout the UK. Women between the ages of 50 and 70 are typically invited for breast screening every three years, but women at high risk can access screening tests before the age of 50 and after the age of 70. Women with a BRCA1 or BRCA2 gene mutation will be considered for yearly MRI scans and mammograms from the age of 30 onwards. Ask your genetic counsellor or GP for further information. Screening aims to detect tumours that are too small to be felt by you or your doctor. Breast screening will not stop women from developing breast cancer, but it will help detect tumours at an early stage, when they are easier to treat.
“My counsellor explained about the increased risk of breast cancer and that I should be screened every year.” Shani
Risk-reducing surgery - bilateral mastectomy (removal of both of your breasts)
For women with a BRCA gene mutation, having surgery to remove both your breasts will greatly reduce your risk of developing breast cancer, but cannot guarantee completely that you will not develop breast cancer. You will be offered the option of having reconstructive surgery to rebuild your breasts using implants and/or tissue from another part of your body. This may be carried out at the same time as your operation, or it may be done at another time as a separate surgery.
Surgery will have a very big impact on you both physically and emotionally, especially following an ovarian cancer diagnosis. It is important that you take your time and discuss all the advantages and disadvantages with a counsellor and your medical team before making a decision. Your medical team will recommend that surgery is not advisable until after you have recovered from your ovarian cancer treatment.
“As I’m still dealing with the aftermath of cancer treatment, the counsellors and clinical team have agreed to discuss preventative surgery in a few more months as I feel I need to take a breath. I think I will have it, but haven’t decided about reconstructive surgery – I have an appointment with the plastic surgeon to help me decide.” Berni
Drug treatment and lifestyle choices
In some cases, ‘chemoprevention’ may be considered to reduce the risk of breast cancer. Chemoprevention is the use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the recurrence of, cancer. This includes treatment with drugs such as tamoxifen and raloxifene. Tamoxifen is usually used as a treatment for breast cancer, and raloxifene is used to treat or prevent osteoporosis (bone thinning) after the menopause. Your genetics doctor or genetic counsellor can discuss this with you and give you written information on the absolute risks and benefits of chemoprevention, including the side effects of the drugs, and the extent of risk-reduction before you make a decision.
Women with ovarian cancer who are carriers of a BRCA1 or BRCA2 gene mutation should be offered advice about other factors which may affect their risk of breast cancer. These include:
- The use of the oral contraceptive pill which has long term protective effects for the risk of ovarian cancer but a short term reversible increased risk of breast cancer.
- The use of hormone replacement therapy (HRT) which depending on your clinical circumstances may increase your risk of developing breast cancer. Your clinician should discuss with you whether the increased risk outweighs the benefit, and what alternatives there are.
- Reducing your alcohol consumption, stopping smoking, and maintaining a healthy weight through healthy eating and exercise to reduce your risk.
There are a number of drugs in use and in development that are targeted at cancers in women with mutations in one of their BRCA genes so it is important to ask your clinician if your genetic test result has an impact on your ability to access different treatments or clinical trials.
PARP inhibitors are a group of drugs which work by stopping cancer cells repairing themselves. There are currently a number of PARP inhibitors at different stages of development and research.
The PARP inhibitor called olaparib (also known as Lynparza) has been licensed to treat ovarian, fallopian tube, and primary peritoneal cancer in women who carry mutations in the BRCA1 or BRCA2 genes and whose cancer has come back. However, access to olaparib is different across the UK, and it depends on the number of recurrences of ovarian cancer you have had so you will need to have a detailed discussion with your clinician about your eligibility for this and other PARP inhibitors.
Participation in treatment clinical trials
The best time to look into participating in clinical trials is when you are first diagnosed with cancer or when you have a recurrence before starting treatment. Some studies have restrictions on the number or the types of prior cancer treatments that a person has received. Talk to your clinician or visit Target Ovarian Cancer’s Clinical Trials Information Centre for information about research on PARP inhibitors and other studies specifically designed for people with BRCA mutations or hereditary cancers.
“I was diagnosed with ovarian cancer in 2009, and subsequently tested positive for a BRCA1 mutation. Following surgery and chemotherapy, I had about 10 months of remission before the cancer returned. I then joined a clinical trial for a PARP inhibitor rather than have more chemotherapy. I was happy to be generally living a normal life with no nasty side effects; my cancer shrunk to “non-measurable disease,” and my CA125 tumour marker went from 204 to 10. I am very grateful for the trial that gave me a fantastic year without chemo. Although the drug stopped working for me after 10 months, it is still working for others, and I am hopeful that my involvement helps others (I have two BRCA-positive daughters).” Sharon
Tumour profile testing
All tumours have genetic mutations that arise as the tumour develops. These are called “somatic” mutations and are not present in the normal healthy cells of a person who has cancer. The inherited mutations referred to throughout the rest of this information which may increase the risk of developing cancer are known as “germline” mutations.
When a tumour is removed during a biopsy or surgery, the tissue will be sent to a pathologist who will study the tissue under a microscope and arrange additional tests on the tissue to profile it. This tumour profiling test gives information about the cells in the somatic mutations, and can help the medical team identify which treatments the tumour is most likely to respond to, and in some cases whether the woman is eligible for certain clinical trials.
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Last reviewed: July 2016
Next review: June 2019