This month is very a big one in women’s health.
First of all, it is National Menopause Awareness Month. The second is that it is National Hereditary Breast and Ovarian Cancer Awareness Week. So, I thought it would be good to discuss a topic that gets too little attention – the inherited potential risk of breast cancer. Since about 5% to 10% of breast cancers are inherited, and since hereditary breast cancer genes affect my family, my goal is for you to have a better understanding of what inherited breast cancer means, your potential risk, what you should do, and some related things to help you live better, healthier, happier, and longer.
What causes the increased hereditary breast cancer risk?
The inherited breast cancer genes are genes that typically work to protect you from the risk of cancer. However, in this situation, they’re mutated and have an abnormal portion. So these genes, which are typically involved in protection against cancer, aren’t able to do their job. So when they are not working perfectly, the risk of cancer goes up. The typical woman has a general life span risk of about 1 in 8 or about a 12% risk of getting breast cancer. But women who have mutated genes for breast cancer can increase that 12% lifetime risk to as high as 75 or 80% and anywhere in between. Other cancers besides breast cancer can be increased if you have these gene mutations.
| Cancer Type | General Population Risk | Risk for Malignancy | |
| BRCA 1 | BRCA 2 | ||
| Breast | 12% | 46% to 87% | 38% to 84% |
| Second Primary Breast | 2% within 5 years | 21.1% within 10 years, 83% by age 70 | 10.8% within 10 yrs, 62% by age 70 |
| Ovarian | 1% to 2% | 39% to 63% | 16.5% to 27% |
| Male breast | 0.1% | 1.2% | Up to 8.9% |
| Prostate | 6% though age 69 | 8.6 by age 65 | 15% by age 65; 20% lifetime |
| Pancreatic | 0.50% | 1% to 3% | 2% to 7% |
| Melanoma (skin & eye) | 1.6% | Elevated risk |
Petrucelli N, Daly MB, Pal T. BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer, https://www.ncbi.nlm.nih.gov/books/NBK1247/ accessed 9-28-17
It’s also important to realize that just because you have mutated genes that put you at increased risk, it doesn’t mean you’ll get breast cancer. But having the genes means that you will be at more risk. Because you’re at greater risk, there are things you need to think about in order to lower that chance.
First of all, what are those genes? Many people are familiar with the BRCA. That’s the Breast Cancer, or BRCA gene. This is the most common of the breast cancer gene that causes a greater risk. And it doesn’t only mean that you’re at an increased risk for breast cancer. As the chart above shows, depending on whether it’s BRCA 1 or 2, you may be at more risk for ovarian cancer as well and an increased risk of certain other cancers such as melanoma skin cancer, a second primary breast cancer, and pancreatic cancer.
Having one of these genes can also have an impact when you have children because your children each have a 50% chance that they could inherit that particular gene from you. If that is the case, then your children will also have this increased risk. The fact that can be passed down from generation to generation, of course, is why there’s a family history.
What gene mutations increase the risk of hereditary breast cancer?
There are a number of gene mutations that can increase your risk of breast cancer in addition to the BRCA 1 and 2 genes. They have names like ATM, sounds like a cash machine, but it isn’t. It’s a gene mutation. BIRIP1, CDH1, CHEK2, PALB2, MRE11A, NBN, PTEN, RAD50, RAD51C and there are several more. The reason I’m mentioning this is it’s not just one gene mutation. So, if you have a strong family history, and you get tested for the BRCA gene and it’s positive, that tells you why. But just because one gene mutation isn’t associated doesn’t mean there couldn’t be others.
Who should be tested?
Everybody doesn’t have to be tested for hereditary breast cancer genes, so who should be?
- Someone with a strong family history of breast or ovarian cancer
- A relative who has triple negative breast cancer
- A family history of other cancers like prostate cancer, melanoma, pancreatic cancer, stomach cancer, thyroid, uterine cancer, or colon cancer
- A woman who has had breast cancer in both breasts
- Ashkenazi Jewish woman
- African-American women diagnosed with breast cancer before or at age 35
- A male in the family who had breast cancer. I know you may be thinking, “What!”, but about 1 in 1,000 men will develop breast cancer
- A known hereditary breast cancer gene in your family
If you have a heads up that you are at increased risk of inherited breast cancer, there are measures that you can do to lower your risk. Of course, we want to lower our risk as much as possible.
5 Things that lower the risk of developing breast cancer
- Maintain a healthy weight
- Don’t smoke. It’s bad. It’s bad for your general health, but it’s also increasing your risk of breast cancer. If you do smoke, stop smoking.
- Eat nutritionally healthy foods. You want to stay away from saturated fats, the trans fats, and processed foods and keep your diet rich in vegetables and fruits
- Limit alcohol. If you’re a woman, more than a glass of wine a day is considered more than the optimal. For men, it’s two drinks a day. That may seem like a lot or a little depending on who you are.
- Regular exercise, getting out there and being active, lowers your risk of breast cancer and hereditary breast cancer. It also improves depression, lowers your blood pressure and your risk of heart disease. Wow! Mom was right. Exercise is good for you.
Here’s a simple rule of thumb to calculate what your weight should be. It’s on average 100 pounds for the first 5 feet and about 5 pounds for each inch over that. So what’s a healthy weight for someone who is 5’2″? Well, of course it depends on your bone size and so forth, but at 5’2″ you want to be somewhere around say 110, 115 pounds, maybe 120 pounds depending on your build. You can also get an estimate of whether your weight is high, low or just right with a mathematical formula called Body Mass Index or BMI.
All those things; limiting alcohol, exercise regularly, maintaining a healthy diet, eating healthy, and not smoking — five things that you can do to lower your risk of breast disease. That’s true whether or not you have genetic diseases.
How to lower your risk of hereditary breast cancer and ovarian cancer
If you have a genetic predisposition for breast or ovarian cancer, your doctor may discuss removing your ovaries and their fallopian tubes sometime around age 35 or 38 or certainly by age 40 for most women in order to lower the risk for both breast and ovarian cancer because some of them like the BRCA increases the risk of breast cancer at an early age. Cancers often start up to 10 years before they are diagnosed, so the goal is to remove the ovaries and Fallopian tubes at least 10 years before a women is believed to be at increased risk.
But having your ovaries removed at a young age creates other issues. You’re going to go into menopause once both ovaries are removed. If you are someone who has delayed having kids, then you may need to consider having eggs frozen if you’re single, or embryos frozen by doing in vitro fertilization if you have a partner. That’s a whole other discussion. Just remember there’s a reproductive side on one end, and a menopause side on the other.
I talk about hereditary breast cancer in my new book called The Estrogen Fix, which explains in detail about hormone therapy and in particular, about hormone therapy and BRCA. A lot of women and their doctors think, for instance, if they have the BRCA gene mutation, and they have surgery to remove their ovaries and tubes that they can’t have estrogen. That’s not necessarily correct. In the Estrogen Fix, I explain that in most instances, even though your ovaries and tubes are removed, you can still in most instances go on hormone therapy. And that makes a huge difference in the quality of your life.
When you visit EstrogenFixBook.com, it will route you to my website where you will receive 9 bonus gifts as a thank you. And then it will take you to your favorite online bookseller. The information in the book will empower you to be prepared and become a partner in your healthcare when you have your next doctor’s visit.
Don’t fear hereditary breast cancer. Figure it out so you won’t have to tough it out.
