BRCA genes and cancer: What you need to know
If you have a family or personal history of cancer, understanding your genes could help you get to know your health better. Genes are like an instruction manual for the body; they provide the body with instructions about how to grow and develop properly. Every person is born with cancer genes. The purpose of these genes is to protect the body from developing cancer.
Some people are born with a change, or mutation, in one of their cancer genes, which causes the gene to be less effective at protecting the body from cancer. Having one of these genetic mutations does not mean that someone will develop cancer; however, it does place people at a higher risk to develop the disease.
Two common genes linked to a greater risk of cancer are the breast cancer 1 and breast cancer 2 genes, known as BRCA1 and BRCA2. People who have a mutation in a BRCA gene are at a higher risk to develop specific cancers, including for breast cancer, ovarian cancer, pancreatic cancer, prostate cancer and melanoma. Fortunately, there are medical management and screening recommendations available for people who have a gene mutation to reduce these cancer risks.
BRCA1 vs. BRCA2
Every person has BRCA1 and BRCA2 genes. The purpose of these genes is to protect the body from developing cancer. People who are born with a mutation in the BRCA1 and/or BRCA2 genes are at a higher risk to develop cancer. The cancer types are similar between the two genes; however, the exact cancer risk level differs in people that have BRCA1 vs. BRCA2 mutations.
For example, women with BRCA1 mutations are at a greater risk to develop breast cancer compared to women with BRCA2 mutations. Men with BRCA2 mutations are at a higher risk to develop prostate cancer compared to men with BRCA1 mutations.
Who is at risk for hereditary cancer?
Less than 1% of people have a mutation in one of their cancer genes, and having a cancer gene mutation doesn’t mean you will get cancer—only that your risk is higher. If you have the following risk factors in your personal and/or family history, talk with your doctor about whether cancer genetic testing makes sense for you.
- Breast cancer, especially before age 50
- Ashkenazi Jewish ancestry
- Male breast cancer
- Ovarian cancer
- Prostate cancer, especially high-grade or metastatic disease
- Pancreatic cancer
- Multiple types of cancers in one person
- Confirmed gene mutation in a blood relative
- Family history of similar cancers
Approximately 10% of breast cancer is hereditary; meaning 1 in 10 people with breast cancer inherited a mutation in one of their cancer genes. Your doctor may refer you to a specially trained genetic counselor to see whether your family falls into this hereditary category. Genetic counseling can help you and your care team better understand your hereditary cancer risk and create a personalized plan to better treat you and your family.
Some people with hereditary breast cancer (i.e. those with a BRCA or PALB2 gene mutation) are also at a higher risk to develop a second primary breast cancer. In second primary breast cancers, a new type of breast cancer develops (usually in the other breast) when you’ve already been diagnosed with a previous breast cancer.
A common type of hereditary breast cancer associated with the BRCA genes, especially BRCA1, is triple-negative breast cancer. Triple-negative breast cancer is a type of cancer that does not have any of the receptors commonly found in breast cancer. As a result, this type of cancer can be fast-growing and harder to treat, so prevention and early detection are important.
Breast cancer gene mutations and ovarian cancer
Along with breast cancer, some gene mutations (including BRCA) affect your chances of developing ovarian cancer, as well as primary peritoneal cancer and cancer in the fallopian tubes. For example, women with a BRCA1 mutation have a 39-58% risk of developing ovarian cancer (compared to the general population risk of 1%). Women with a PALB2 gene mutation are also at an increased risk (3-5%) of developing ovarian cancer.
If you have a gene mutation, your care team will talk with you about options to reduce your risk so you can feel confident in your health and future.
Breast cancer gene mutations and other cancers
While breast cancer is the most common type of cancer caused by breast cancer genes, certain gene mutations also place people at a higher risk for other types of cancers. For example, people with CHEK2 gene mutations are at an increased risk for breast, colorectal and possibly other cancers. As part of your care, you’ll have access to treatment and prevention for these cancer types, as well as the latest advancements in research.
Genetic counseling and testing
If you have a personal and/or family history of breast cancer, genetic counseling and genetic testing can give you the resources you need to make informed choices about your health.
Our genetic counseling and high-risk assessment programs give you a team that specializes in ordering personalized genetic tests and navigating care for people with positive test results. Based on your individual risk profile, we’ll recommend your next steps for care and prevention, as well as testing for other members of your family.
Can you get breast cancer without a BRCA gene mutation?
Yes, you can get breast cancer without a BRCA gene mutation. BRCA gene mutations are rare, and only a small percentage of breast cancers are related to the BRCA gene. Most people with breast cancer do not have a genetic cause, and the majority do not have a family history of breast cancer. You can also have a BRCA gene mutation and never develop breast cancer.
Can you only inherit a breast cancer gene mutation from your mother?<p>No. You can inherit a breast cancer gene mutation from your mother or father. Most people have two copies of each gene, one inherited from their mother and one from their father. As such, it is equally likely to inherit a breast cancer gene mutation (such as <em>BRCA</em>) from your father. That’s why it’s important to consider both sides of your family history of cancer.</p>
Do breast cancer gene mutations only affect women?
No. Breast cancer gene mutations can also place men at a higher risk for cancer. For example, men with a BRCA2 gene mutation are at a higher risk to develop male breast cancer, prostate cancer, pancreatic cancer and melanoma. It is equally important for men to receive genetic counseling and testing based on their family history of breast cancer.
How will genetic testing help me if I already have cancer?
Genetic testing can help identify whether you inherited a gene mutation that caused your cancer, and if so, this information can help doctors treat you more effectively. Genetic testing may also help identify other cancers you could be at an increased risk for and help guide screening and surveillance recommendations based on this risk. Knowing if your cancer is inherited can also help determine who else in your family is at risk and steps they can take to reduce the cancer risk.
Can my insurance company discriminate against me based on the results of my genetic test?
No. The Genetic Information Nondiscrimination Act of 2008 (GINA) protects you and your genetic information from being used (in a company with 15 or more employees) in employment decisions and when determining your eligibility for medical insurance. This helps ensure that you can pursue genetic testing and medical care, as well as participate in clinical research, without fear of having that information used against you or your family members. Be aware that GINA does not protect you against discrimination in the purchase of life, disability or long-term care insurance. Additionally, this law does not apply to members of the US military, veterans obtaining healthcare through the Veteran’s Administration, individuals using the Indian Health Service, or federal employees enrolled in the Federal Employees Health Benefits program. Most of these entities have their own genetic anti-discrimination laws.
How much does genetic counseling and genetic testing cost, and will insurance cover it?
Health insurance often pays for genetic counseling. In many cases, it pays for genetic testing when it is recommended by a genetic counselor. However, different companies have different policies and as with most healthcare services, you may need to pay for some of the cost. A genetic counselor can guide you through potential out-of-pocket costs for genetic testing.