I am 41. How can I reduce the risk of getting breast cancer?

Question

Hello doctor,

I am 41, and my sister was just diagnosed with breast cancer at 43. Our oncologist strongly recommends genetic testing for our family. My mother died from ovarian cancer at 57, and my maternal aunt had breast cancer at 49, suggesting a hereditary pattern. I am terrified about testing positive for a BRCA mutation and what that might mean for the future of my two teenage daughters.

If I do have the gene mutation, would I need a preventive mastectomy or ovary removal even though I do not currently have cancer? Insurance coverage for testing and preventive procedures is unclear, which adds financial stress to my health anxiety. My daughters are young. When should they be tested, and how do I explain this burden to them?

Testing positive might affect my ability to get life insurance or impact my employment, which worries me greatly. But not knowing also keeps me constantly anxious about developing cancer like my mother and sister. What is involved in the genetic testing and counseling process? What are the realistic risk percentages if I test positive for a BRCA mutation?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I completely understand the fear and anxiety you are experiencing when someone in the family is diagnosed with cancer. Since there are already several cancer cases in your family, I fully agree with your doctor’s recommendation that you undergo genetic testing, as it is very important in your situation.

Let me explain a few things. The BRCA (breast cancer gene) test shows the probability of developing breast cancer, around 50 percent, and the probability of developing a primary cancer in general, about 10 percent. This means it does not confirm that you will develop cancer; it only indicates the likelihood.

Regarding insurance, if you submit documents showing that your mother, aunt, and sister have had cancer, insurance often covers the cost of testing. If it does not, you may be able to join a clinical trial run by large pharmaceutical companies, and they may cover the cost of genetic testing.

I also want to reassure you that a preventive mastectomy is not always necessary to protect yourself from breast cancer. Hormonal therapy can be used as a preventive measure to reduce the risk of developing breast cancer. Another simpler option is active surveillance, which involves having a mammogram or breast MRI (magnetic resonance imaging) every year to ensure there are no signs of cancer.

Unfortunately, there is no hormonal therapy that can prevent ovarian cancer. However, if you have completed your family and do not plan to have more children, you may consider removing both ovaries, a procedure called RRBSO (risk-reducing bilateral salpingo-oophorectomy).

As for your daughters, they are still young, but once they reach 25 years of age, they should be tested for BRCA, especially if your result is positive. Based on each daughter’s situation, we can then create a personalized plan to best protect her from breast and ovarian cancer.

I want to reassure you that cancer is not what it used to be; there are now treatments and preventive options for every condition. Right now, we are in the prevention stage with you, and that is a very good place to be. I strongly recommend that you proceed with the test, and once the results are available, we will decide together on the most appropriate preventive steps for you.

I hope my explanation was clear and helped ease your mind. If you ever have any questions, I am always here to help.

Thank you.