Introduction to risk management

Overview |
Risk factors |
Risk management options |
Further reading

Overview

Cancer risk assessment, risk factors and risk management options may differ for people with hereditary cancer risk or a BRCA mutation than for people in the general population. It is important to consult an expert in cancer risk assessment and risk management to determine what your personal risk for hereditary cancer may be. For more information, see our finding a specialist in hereditary cancer section.

Risk factors

Cancer is a disease with many contributing factors. The following factors may impact the risk for cancer; some may have a different impact for BRCA mutation carriers or people with hereditary cancer risk than people with average cancer risk. Currently it is unknown precisely how risk factors alone or in combination impact someone with a BRCA mutation or hereditary cancer risk.

Age at menarche (first menstruation)
- In the general population, early menarche has been shown to increase the risk for breast cancer. One study showed similar effect in women with BRCA 1 mutations. Earlier age of first menstruation was associated with an increased risk of breast cancer. This association was not observed among BRCA2 mutation carriers. Compared with BRCA1 carriers who began menstruation at 11 years, women who began menstruation between ages 14 and 15 had a 54% reduction in risk.
Parity (number of births)
- In the general population, having children before age 30 has been shown to lower the risk for breast cancer. The exact impact of pregnancy and child-bearing on breast cancer risk in BRCA mutation carriers is not totally clear and may be different for BRCA 1 mutation carriers than for BRCA 2 mutation carriers. In one study women with a BRCA 1 mutation who had four or more children had a breast cancer risk that was 38% lower than BRCA 1 mutation carriers who never had children. The same study associated increasing number of births with a significant increase in breast cancer risk in BRCA2 mutation carriers before age 50. The increase was greatest in the 2-year period following a pregnancy.
Breast-feeding
- One study examined breast cancer incidence in BRCA 1 and BRCA 2 carriers who breast-fed compared with women who never breast-fed. The study found that breast-feeding lowered the risk for breast cancer in BRCA 1mutation carriers who breast-fed for more than one year, but did not find a similar risk reduction in BRCA 2 carriers.
Medications
- Certain medications such as Tamoxifen may lower the risk for breast cancer in BRCA mutation carriers. Other medications such as oral contraceptives have been shown to lower the risk for ovarian cancer but certain formulations may increase the risk for breast cancer in BRCA carriers. For more information on the effects of medication on cancer risk, visit our section on breast cancer chemoprevention and ovarian cancer chemoprevention.
Prior surgery
- Prophylactic salpingo-oophorectomy (surgical removal of the ovaries and tubes) in high-risk women has been shown to dramatically lower the risk for ovarian cancer. If the procedure is done prior to menopause, it has also been shown to lower the risk for breast cancer substantially. For more information, see our prophylactic salpingo-oophorectomy section. In addition, a small retrospective study found that tubal ligation substantially lowered the risk for ovarian cancer in women with BRCA 1 mutations but not in women with BRCA 2 mutations.
Diet
- Although it is believed that certain foods or chemicals in certain foods such as vegetables, fat, dairy and soy may affect breast and/or ovarian cancer risk, the exact effect of diet and its impact on those at risk for hereditary cancer is unknown.
Exercise
- Exercise offers many health benefits for both BRCA mutation carriers as well as the general population. A study of Jewish women with BRCA mutations showed those active in sports, dance, or casual exercise during their teenage years had a delayed the onset of breast cancer later in life.
Weight
- A recent study of 1,073 women from five countries suggests losing as few as 10 pounds between ages 18 and 30 may dramatically reduce the risk for breast cancer in those who have a BRCA1 mutation.
Alcohol consumption
- Regular alcohol consumption has been linked to increased risk for breast cancer risk for women in the general population. The specific effect of alcohol consumption on breast cancer risk in BRCA mutation carriers is unknown.

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Risk management options

Women with BRCA mutations have options for managing their risks for breast and ovarian cancer. The most appropriate options differ between women and depend on many considerations. In general there are 3 categories of risk management options which are outlined below and are discussed in more detail in their respective sections.

chemoprevention
- chemoprevention for breast cancer
- chemoprevention for ovarian cancer
Surveillance
- surveillance for ovarian cancer
- surveillance for breast cancer
Prophylactic (risk-reducing) surgery
- mastectomy
- oophorectomy

The National Comprehensive Cancer Network (NCCN) is a consortium of cancer centers with experts in management of hereditary cancer. The NCCN updates their guidelines for risk management for people with hereditary risk for cancer, based on the latest research. In general, NCCN guidelines dictate the standard of care for high-risk patients.

It is important to remember that none of the risk-management options will eliminate all cancer risk. Some risk always remains, even with the surgical options.

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Further reading - articles (advanced reading)

Age at menarche and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers
Joanne Kotsopoulos, Jan Lubinski, Henry T. Lynch, Susan L. Neuhausen, Parviz Ghadirian, Claudine Isaacs, Barbara Weber, Charmaine Kim-Sing, William D. Foulkes, Ruth Gershoni-Baruch, Peter Ainsworth, Eitan Friedman, Mary Daly, Judy E. Garber, Beth Karlan, Olufunmilayo I. Olopade, Nadine Tung, Howard M. Saal, Andrea Eisen, Michael Osborne, Hakan Olsson, Dawna Gilchrist, Ping Sun, Steven A. Narod. Cancer Causes and Control. Volume 16, Number 6: p. 667-674, August 2005.

Changes in body weight and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers
Joanne Kotsopoulos, Olufunmilayo I Olopado, Parviz Ghadirian, Jan Lubinski, Henry T Lynch, Claudine Isaacs, Barbara Weber, Charmaine Kim-Sing, Peter Ainsworth, William D Foulkes, Andrea Eisen, Ping Sun, Steven A Narod. Breast Cancer Research. Volume 7, Number 5:p. 833-843, July 2005.

Effect of pregnancy as a risk factor for breast cancer in BRCA1/BRCA2 mutation carriers
Carey A. Cullinane, Jan Lubinski, Susan L. Neuhausen, Parviz Ghadirian, Henry T. Lynch, Claudine Isaacs, Barbara Weber, Pal Moller, Kenneth Offit, Charmaine Kim-Sing 10, Eitan Friedman, Susan Randall, Barbara Pasini, Peter Ainsworth, Ruth Gershoni-Baruch, William D. Foulkes, Jan Klijn, Nadine Tung, Gad Rennert, Olufunmilayo Olopade, Fergus Couch, Teresa Wagner, Hakan Olsson, Ping Sun, Jeffrey N. Weitzel, Steven A. Narod. International Journal of Cancer. June 2005. (Published ahead of print version).

Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers
Helena Jernström, J. Lubinski, H. T. Lynch, P. Ghadirian, S. Neuhausen, C. Isaacs, B. L. Weber, D. Horsman, B. Rosen, W. D. Foulkes, E. Friedman, R. Gershoni-Baruch, P. Ainsworth, M. Daly, J. Garber, H. Olsson, P. Sun, S. A. Narod. Journal of the National Cancer Institute. Volume 96, Number 14: p. 1094-1098, July 2004.

Smoking and the risk of breast cancer among carriers of BRCA mutations
Parviz Ghadirian, Jan Lubinski, Henry Lynch, Susan L. Neuhausen, Barbara Weber, Claudine Isaacs, Ruth-Gershoni Baruch, Susan Randall, Peter Ainsworth, Eitan Freidman, Douglas Horsman, Patricia Tonin, William D. Foulkes, Nadine Tung, Ping Sun, Steven A. Narod. International Journal of Cancer. Volume 110, Number 3: p 413-416, June 2004.

Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2
King MC, Marks JH, Mandell JB; New York Breast Cancer Study Group. Science. Volume 24, p. 643-6, October 2003.

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Risk Management

Introduction to risk management

Overview

Risk factors

Risk management options

Further reading - articles (advanced reading)