Hereditary Cancer

Image Source: Scientific American
Image Source: Scientific American

Yes, you can be more likely to get cancer because of your genes, but you don’t have to resign yourself to getting breast cancer. You may have heard a lot lately about hereditary breast cancer, specifically the BRCA1 and BRCA2 genes, (think Angelina Jolie) or maybe this is your first exposure to the concept of “hereditary cancer”, but regardless, we are here to help answer some questions you may have.

My mother/grandmother/sister/aunt had breast cancer. Does that mean I will definitely get breast cancer?

Short answer: No.

Long answer: You are at higher risk for developing breast cancer if you have a relative who had breast cancer, but that doesn’t mean you are destined for it. The best course of action would be for you to first, talk to your doctor about your individual risks, and second, see if you can visit a genetic counselor.

Genetic counselors “work as members of a health care team, providing information and support to families who have members with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions. They identify families at risk, investigate the problem present in the family, interpret information about the disorder, analyze inheritance patterns and risks of recurrence and review available options with the family.”(National Society of Genetic Counselors)

If you do test positive for a genetic mutation, genetic counselors can help you figure out your risk for breast cancer and perhaps other cancers. Not every gene mutation carries with it the same risk for breast cancer. You can work with them along with your doctor to decide what preventive measures you wish to take, if any.

I tested positive for a genetic mutation that increases my risk of breast cancer. What do I do now?

That is a very difficult question with many, many different answers. First, we suggest you talk to your doctor about your options. Options could range from doing nothing, starting screenings early or having them more frequently, taking medication to suppress hormones, or even having a preventive (prophylactic) mastectomy. These decisions are very personal and are best made in conversations with your doctor and your loved ones, but the choice is ultimately your own. One group that can provide support is FORCE, or Facing Our Risk of Cancer Empowered. This is an online community of people who are all at a higher risk of developing breast and ovarian cancer, and they also have in-person group meetings in Northern Virginia, Richmond, and Virginia Beach. If you want to read a personal story of a young woman in Virginia who is dealing with being BRCA1 postive (and the decisions that come with it), please check out this blog.

I got tested for BRCA1 and BRCA2 a few years ago and the tests came back negative. Does that mean I won’t get breast cancer?

The only thing a negative test for BRCA1 and BRCA2 mutations means is that you do not have the specific mutations they tested you for. There have been huge advancements in this area of medicine, and there are now at least six different genetic mutations that you can be tested for to determine your risk of breast cancer. If you haven’t been tested in a few years, it might be worth calling a genetic counselor and being tested for these new mutations. New mutations continue to be discovered, so if you have a strong family history of breast (or any) cancer but continue to come up negative for the known genetic mutations, consider re-testing every 3-5 years or so, depending on recommendations from your doctor and genetic counselor. With all of that being said, only 5-10% of breast cancers have any known genetic cause, so testing negative for gene mutations does not mean you won’t ever get breast cancer.

Only family members on my dad’s side have had breast cancer, so that doesn’t count, right?

A common misconception is that breast cancer risk can be passed down only on the mother’s side. When people are conceived, both the mother and the father contribute equally to their child’s genetic makeup. This means that men can pass on a genetic risk for breast cancer to their children. In fact, it might be a good idea for a father with a high incidence of breast cancer in his family to be tested for genetic mutations like BRCA1 and BRCA2 to see if he could have passed a mutation down to his children. If the father does not have the mutations, then he cannot pass them on to his children.

No one in my family has had breast cancer. That means I don’t have to get a mammogram, right?

Wrong. Because only 5-10% of breast cancer diagnoses are genetic, that leaves a majority of breast cancers that are due to other causes. Genes are not the only risk factors for breast cancer. Not having children, not breast feeding, being obese, and just normal aging are breast cancer risk factors for women. Yes, your risk is drastically reduced if you don’t have a family member who has had breast cancer; however, it is still a good idea to start getting your annual mammograms when your doctor thinks it is appropriate (recommendations for women of average risk range from 40 to 50) and to do some basic self-checks in between mammograms.