Women who are genetically more likely to develop breast cancer may have some difficult decisions to make, but those with the BRCA gene mutation should approach those choices armed with the proper information, according to a Longstreet Clinic physician.
According to the National Cancer Institute, BRCA1 and BRCA2 are genes that produce tumor suppressor proteins that help repair damaged DNA. When one of those genes is mutated, DNA damage may not be repaired properly, and cells are more likely to develop additional mutations that can lead to cancer.
About 10 to 12 percent of women overall get breast cancer before age 90, according to Dr. Priscilla Strom with the Longstreet Clinic’s Breast Center. But for women with the BRCA gene, that risk can rise to about 70 percent, according to the National Cancer Institute.
However, Strom said she does not recommend people who have never had breast cancer get tested for the BRCA gene. Instead, a relative who has or had cancer should be tested, if they are alive and willing to do so. Strom also advises against getting tested for the gene before age 25.
“If there is a person in her family with the cancer who has not been tested, the person with the cancer is the person who needs to get tested,” Strom said. “Most people with breast cancer do not have the gene, and if the person in your family who has breast cancer does not have the gene, the chance of you having the gene is essentially zero, so there’s no reason for you to get tested.”
Only about 5 percent of women who develop breast cancer have the BRCA gene, Strom said.
The BRCA gene mutation can be inherited from both the mother and father, so people should look at both sides of their families for a history of breast cancer. Each child of a parent who carries the mutation has a 50 percent chance of inheriting the mutation, according to the National Cancer Institute.
If someone does test positive for the BRCA gene, they have several options. They should increase screening for breast cancer, including getting MRIs rather than mammograms. Women can also reduce their risk of getting breast cancer by taking an anti-estrogen medication such as tamoxifen.
The most permanent decision is getting a mastectomy proactively, which Strom said reduces the risk of developing breast cancer to about 1 to 2 percent.
To some, that option may seem extreme. And Strom said she works to ensure her patients understand their options before deciding to get a mastectomy.
“I spend more time talking people out of mastectomies than I do talking them into mastectomies,” she said. “They come in here already having made their minds up.”
The BRCA gene can induce fear in people who have seen a loved one struggle with breast cancer. Strom said she understands why her patients may have an emotional connection to the issue.
“People do it out of fear,” Strom said. “Part of my job is to ratchet that fear back down to reasonable levels, to say that, I understand that you saw your mother die of breast cancer, so I understand you don’t want to do that. But let’s think of other things, too.”