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BRCA Gene Mutations and Cancer

genetic risk breast cancerBRCA gene mutations have been in the news this week since Angelina Jolie announced she has the BRCA1 gene mutation and opted to have a bilateral mastectomy to reduce her risks of developing breast cancer. She became aware of her risk because her mother developed breast cancer in her mid-40s and died at age 56. What exactly are the so-called breast cancer genes and who should be tested to see if they are a carrier?

Two genes, BRCA1 and BRCA2, if mutated are known to dramatically increase a woman’s risk of developing breast and ovarian cancer. Men can also carry these genes, and if they have a gene mutation, which also puts them at risk for developing breast and other cancers, though their breast cancer risk is not nearly as much as in women. These mutations are so-called germline mutations, that is, they are acquired at conception from either their mother or father. If a parent has a BRCA gene mutation, each child has a 50 percent likelihood of acquiring that mutation. Each year, a group called the National Comprehensive Cancer Network, reviews the latest research and develops the guidelines of who should be tested for these gene mutations. Current guidelines recommend screenings for:

  • women and men who have a strong family history of breast and/or ovarian cancer on either the maternal or paternal side of their family
  • women and men who developed breast cancer, particularly bilateral breast cancer, at a young age (under age 50)
  • women who developed ovarian cancer at a young age
  • women who have men in the family with breast cancer

The screening is a simple blood test, but it is expensive (around $4,000) and, due to patent restrictions, is performed by only one lab in the United States. For that reason, we must conserve resources and only test those individuals who meet the testing criteria.

Individuals who carry the BRCA1 gene mutation have a 60% to 85% chance of developing breast cancer and an approximately 40% chance of developing ovarian cancer. Those with the BRCA2 gene have 40% to 60% chance of developing breast cancer and about a 20% chance of developing ovarian cancer. After learning you have one of these gene mutations, there are several decisions to make.

At a minimum, women with BRCA gene mutations should undergo aggressive surveillance.  This typically consists of an annual mammogram and breast MRI starting at age 25. This allows us to detect breast cancers sooner, if it does develop, at an early and more treatable stage. Like Ms. Jolie, some patients choose the risk-reduction bilateral mastectomy and breast reconstruction, which reduces their risk of developing breast cancer by 93%. However, there is no data currently that compares the mortality rate of those who choose bilateral mastectomy versus those who opt for aggressive screening.

Unfortunately, we currently do not have reliable surveillance methods for early diagnosis of ovarian cancer that are as effective as mammograms and breast MRI are for breast cancer. For women who have the BRCA1 or BRCA2 gene mutation, we do recommend removal of their ovaries and fallopian tubes after they are done having children, typically between the ages of 35 and 40.

If you feel you may be at an increased risk for carrying one of these genes, it’s important to discuss your family history with your healthcare provider. He or she can recommend a course of action. For those who find they have either the BRCA1 and BRCA2 gene, the University of Michigan Comprehensive Cancer Center has a wealth of resources to help you understand your options.

Additional Resources:

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mark pearlman mdMark Pearlman, MD, is vice chair and service chief in the Department of Obstetrics and Gynecology at the University of Michigan Von Voigtlander Women’s Hospital. He also holds an appointment as professor in the Department of Surgery and is associate chief of clinical affairs for the University of Michigan Hospitals and Health Centers. Dr. Pearlman is a member of the surgical staff of U-M’s Breast Care Center, with particular expertise in the management of gynecologic care for women with increased genetic risks for breast and ovarian cancer, gynecologic care of women with breast cancer, as well as the management of benign breast disease.

university of michigan women's hospitalThe University of Michigan’s Women’s Von Voigtlander Women’s Hospital is a leader women’s health care.  Consistently ranked among the America’s top gynecology programs by U.S. News & World Report, U-M is committed to unsurpassed patient care.

 

 

CCC 25 years button150x150The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan for cancer patient care. Seventeen multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.

5 thoughts on “BRCA Gene Mutations and Cancer

  1. avatar
    Sarah on said:

    While I am glad this test is available for people who have an increased risk for the mutated gene, I am saddened by the fact that it isn’t available to everyone. Just because a person doesn’t fit the criteria of being someone with an “increased risk” doesn’t mean that the same person has no risk at all. I hope that someday very soon this test is more widely available – especially given that it is minimally invasive and could potentially save millions of lives. Many people don’t have access to or know their family histories. I think limiting the test to a select few all because of a patent (i.e. money) is ridiculous.

  2. Mutations are not only a hallmark of cancer but may be central to how cancers evolve. Cancer cells divide where normal cells do not; they invade, metastasize and kill the host of origin. The facts that cancer is inheritable at the cellular level and that cancer cells contain multiple mutations, suggest that tumor progression is driven by mutagenesis.

  3. avatar
    Michelle Marion on said:

    For Mark Pearlman, MD:
    I had endometriosis lahsered off at the age of 26. I am currently 51 years of age. Is there an exam that can check for this? I have had some uncomfortness in the lower left ovary and feelings of small spasms. I heard of your special program. I know that I am going through menopause but, my stomach has been gaining in the wasteline as well. Can I be recommended as a new patient to yourself or a coworker?

    • avatar
      Rebecca Priest - U-M Women's Services Marketing & Communications on said:

      I am so sorry that your comment was not addressed in a timely manner. Somehow we managed to miss it when it was initially submitted, and I apologize for that! If this is still something you have concerns about, we welcome you to call to schedule an appointment at one of our clinics: 855-589-6626. Thanks for your comment, and again – we apologize for not having responded sooner!

  4. avatar
    Robert P Goldman, MD on said:

    Dr. Pearlman, I read your editorial in the Green Journal and I looked at reference 1, page 1. Total breast cancer deaths for 2013 were 39,620. This number has remained basically unchanged for the last 25-30 years despite huge increases in the number of women diagnosed and treated for breast cancer. Total treated yearly has risen from around 70,000/year 30 years ago to around 300,000/year now. Yet, total mortality has remained around 35,000 to 40,000/year despite all that treatment. Neither you nor Drs Mark and Temkin discuss the pathophysiology of the disease. Metastatic disease kills women and the current therapy does not kill metastases. Mammogram detection is way too late to prevent the early distant microscopic spread from aggressive tumors. If the program really worked, shouldn’t we have much lower annual deaths by now?

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