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How can I manage my increased risk of breast 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 predictions of whether your ovarian cancer might grow or change. You may also be referred to a family history breast cancer clinic where specialists in this area will take over your care.

Screening

Over coffee - NorwichThe NHS runs a breast screening programme for women throughout the UK. Women between the ages of 50-70 are typically invited for breast screening every three years, but women at high risk can access screening tests before the age of 50 and any woman can request screening to continue 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 30-40 onwards. Ask your genetic counsellor 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 may be an option to greatly reduce your risk of developing breast cancer. Your medical team may recommend that you don’t have this surgery until after you have recovered from your ovarian cancer treatment. Risk-reducing breast surgery cannot guarantee that you will not develop breast cancer, but the risk afterwards is small enough that breast screening is not needed. Most women are offered the option of having reconstructive surgery to rebuild both breasts using implants and/or tissue from another part of your body. This may be carried out at the same time as the natural breast tissue is removed, 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.

“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, anastrazole and raloxifene. Tamoxifen and anastrazole are usually used as treatments for breast cancer, and raloxifene is used to treat or prevent osteoporosis (bone thinning) after the menopause. In this situation they are given to reduce the chance of you developing breast cancer. Your genetics doctor, genetic counsellor or breast cancer specialist 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 how much they might reduce the risk, 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 can increase the risk of breast cancer. (If a woman stops taking the pill, this increased risk of breast cancer drops down again).
     
  • 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 how much alcohol you drink, stopping smoking, and maintaining a healthy weight through healthy eating and exercise to reduce your risk.

What are the implications for my treatment for ovarian cancer?

Looking at the guideThere 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

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. 

As a maintenance treatment following your first course of platinum-based chemotherapy

If you have a BRCA1 or BRCA2 mutation and are diagnosed with ovarian cancer at Stage III or IV (sometimes called advanced ovarian cancer) your treatment will usually involve a combination of chemotherapy and surgery. This treatment can be very effective but unfortunately some women will need to have more treatment in the future because their cancer will start growing again. A maintenance treatment tries to give women as much time as possible before this happens.

A clinical trial called SOLO1 looked at whether a PARP inhibitor called olaparib (also known as Lynparza®) could be used as a maintenance treatment for women with a BRCA1 or BRCA2 mutation who have been diagnosed with ovarian cancer at Stage III or IV. The researchers measured whether taking olaparib tablets after chemotherapy and surgery would keep ovarian cancer under control for longer than not taking the tablets after chemotherapy and surgery. The first results of this trial were published in 2018 and suggest that using a PARP inhibitor in this situation can help keep ovarian cancer under control for longer than standard treatment. At the time of writing, this data is very new and this treatment is not currently available on the NHS. Other PARP inhibitors are also being investigated in this setting and we hope the results of these studies will be available in the near future.

As a maintenance treatment following your second (or more) course of platinum-based chemotherapy

If your ovarian cancer returns (recurs) six months or more after you have had treatment with platinum-based chemotherapy (carboplatin or cisplatin) your medical team will usually talk to you about having treatment with platinum-based chemotherapy again. There have been several studies which have shown that taking a PARP inhibitor (as a maintenance treatment) after chemotherapy in this setting can keep ovarian cancer under control for longer than chemotherapy alone. The PARP inhibitors that have been shown to help in this setting are olaparib (Lynparza®), niraparib (Zejula®) and rucaparib (Rubraca®). At the moment if you have recurrent ovarian cancer (cancer that has come back more than six months after your last treatment with platinum-based chemotherapy) and a BRCA1 or BRCA2 mutation you are eligible for (allowed to have) a PARP inhibitor as a maintenance treatment after chemotherapy. The exact PARP inhibitor you get will depend on where you live in the UK and your individual situation.

As a solo treatment

There is some evidence that PARP inhibitors can be effective as a treatment on their own instead of intravenous chemotherapy (chemotherapy that is given through a drip in your veins) but there is less research about this than using PARP inhibitors as a maintenance treatment. Your medical team will be able to talk with you about the best treatments for your individual situation.

Taking part in clinical trials about treatment

The best time to look into participating in clinical trials is when you are first diagnosed with cancer, or when your cancer has come back, before starting treatment. Some studies have restrictions on the number or the types of cancer treatments that you’ve had before. 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 a with BRCA1 or BRCA2 mutation or hereditary ovarian cancer. 

“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.

Find out more

 

The information on this page is reviewed regularly and is in line with accepted national and international guidelines. All of our publications undergo an expert peer review and are reviewed by women with ovarian cancer to ensure that we provide accurate and high-quality information. More information about our information standards can be found here.

Last reviewed: February 2020
Next review: April 2022