Does BRCA testing help me prevent breast cancer early?

Question

Hi doctor,

I am 41, and I'm really starting to get scared of my family history of cancer. My mother died of breast cancer at 49, my maternal aunt got ovarian cancer at 46, and my grandmother had both breast and ovarian cancers.

My gynaecologist suggested BRCA genetic testing, but I’m afraid of the results and what they might mean for my future. She talked about prophylactic mastectomy and removal of my ovaries if I test positive for a BRCA mutation, which sounds extreme when I don’t even have cancer yet.

I have three daughters, 10, 13, and 16 years old and I worry about giving this gene mutation to them. My husband is supportive but doesn't really understand the gravity of this decision or how this could impact our intimacy if I go through with preventative surgery.

I am worried about genetic discrimination, too. Will this information affect my life insurance, my health insurance, or even my job? The genetic counsellor said there are other genes that can be tested, such as PALB2, CHEK2 and ATM but I’m not sure I want to know every possible risk.

Is it better to get tested when you are older or is it better, always, to get tested sooner for screening?
What if the data shows greater risk, but not certainty?
How do you make life-changing decisions based on probabilities?

Please help .

Answer 1

Hi,

Welcome to icliniq.com.

You are absolutely right, and it's impressive that you are even facing these choices. Given your strong family history of breast and ovarian cancer, your gynecologist is right to recommend BRCA genetic testing. Testing does not force you to make decisions. It simply gives you information that you can use at your own pace. Many women choose regular screening and close monitoring rather than taking immediate action.

Testing positive means there is a higher risk, but not a certainty, of developing cancer. Preventive surgeries are an option, not a requirement. They can include:

Mastectomy.
Oophorectomy.

Many women take years to decide or choose less invasive surveillance, such as:

Annual magnetic resonance imaging scans.
Ultrasound.

As for your daughters, knowing your situation can actually give them the opportunity to make informed decisions when they are older. They do not need to be tested now, but as adults, they can decide based on the available information.

You are also right to be concerned about genetic discrimination. This is protected under laws such as the Genetic Information Nondiscrimination Act (GINA) in many countries, although protections can vary for life insurance. It is best to consult a genetic counselor or legal advisor before disclosing your results.

Testing shifts decisions from fear to informed choice. It is okay if you are not ready now, but you do not have to go through this alone. A genetic counselor can support you both emotionally and practically through every step. You are not making this decision out of fear. You are making it out of love, strength, and a desire to protect your future and your daughters.

Thank you.