If you are a woman with a family health history of breast or ovarian cancer, you may be more likely to get these cancers yourself. Collecting your family health history and sharing this information with your doctor can help you find out if you’re at higher risk. If so, you can take steps to lower your risk.
Each year, over 250,000 women in the United States learn that they have breast cancer and more than 20,000 find out that they have ovarian cancer. While most of these cancers happen by chance, some are hereditary, meaning that they are caused by genetic changes (called mutations) which are passed down in families.
Effective medical options are available for women at risk for hereditary breast and ovarian cancer that can make them less likely to get these cancers. Because of this, all women should learn about their family health history of breast and ovarian cancer to know if they could be at risk for hereditary breast and ovarian cancer.
The first step to find out if you are at risk is to collect your family health history of breast and ovarian cancer and share this information with your doctor. If your family health history shows that you could be at risk for hereditary breast and ovarian cancer, your doctor may refer you for genetic counseling and genetic testing.
The BRCA1 and BRCA2 Genes
The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. About 3% of breast cancers (about 7,500 women per year) and 10% of ovarian cancers (about 2,000 women per year) result from inherited mutations in the BRCA1 and BRCA2 genes.
Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But some mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers. However, not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer.
Everyone has two copies of the BRCA1 and BRCA2 genes, one copy inherited from their mother and one from their father. Even if a person inherits a BRCA1 or BRCA2 mutation from one parent, they still have the normal copy of the BRCA1 or BRCA2 gene from the other parent. Cancer occurs when a second mutation happens that affects the normal copy of the gene, so that the person no longer has a BRCA1 or BRCA2 gene that works properly. Unlike the inherited BRCA1 or BRCA2 mutation, the second mutation would not be present throughout the person’s body, but would only be present in the cancer tissue.
Breast and ovarian cancer can also be caused by inherited mutations in genes other than BRCA1 and BRCA2. This means that in some families with a history of breast and ovarian cancer, family members will not have mutations in BRCA1 or BRCA2, but can have mutations in one of these other genes. These mutations might be identified through genetic testing using multigene panels, which look for mutations in several different genes at the same time.
You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Family members who inherit BRCA1 and BRCA2 mutations usually share the same mutation. If one of your family members has a known BRCA1 or BRCA2 mutation, other family members who get genetic testing should be checked for that mutation.
If you are concerned that you could have a BRCA1, BRCA2, or other mutation related to breast and ovarian cancer, the first step is to collect your family health history of breast and ovarian cancer and share this information with your doctor.
Family Health History and the BRCA1 and BRCA2 genes
Breast and ovarian cancers that run in families can be caused by genetic changes, or mutations, most commonly in the BRCA1 and BRCA2 genes. You can use the My Family Health Portrait tool to collect your family health history of breast, ovarian, and other cancers and share this information with your doctor. Your personal and family health history information can help your doctor decide whether to refer you for genetic counseling to find out if genetic testing might be right for you. It’s important to know that not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer. Also, not all inherited forms of breast or ovarian cancer are due to mutations in the BRCA1 and BRCA2 genes.
Can men get breast cancer? Men and BRCA-related cancers
Although breast cancer is much more common in women, men with BRCA1 or BRCA2 mutations are more likely to get breast cancer than other men. In addition, men with BRCA mutations are more likely to get high grade prostate cancer. Both men and women with BRCA mutations are more likely to get pancreatic cancer.
You can inherit BRCA1, BRCA2, and other mutations from your mother or your father, so be sure to include information from both sides of your family when collecting your family health history. Include information on your parents, sisters, brothers, children, grandparents, aunts, uncles, nieces, nephews, and grandchildren. Include information about your ancestry, if you know it. BRCA1 and BRCA2 mutations are more common in people with Ashkenazi Jewish or Eastern European ancestry. Tell your doctor if you are concerned about your family health history, especially if you or your close relatives have or had any of the following:
- Breast cancer, especially at a younger age (age 50 or younger)
- Ovarian, peritoneal or fallopian tube cancer
- Triple negative breast cancer (Triple negative cancers are a type of breast cancer that lack estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2)
- Cancer in both breasts
- Breast cancer in a male relative
- Pancreatic cancer
- Metastatic or high grade prostate cancer
- Multiple cancers in the family, including breast, ovarian, high grade prostate, or pancreatic cancer
- Ashkenazi or Eastern European Jewish ancestry
- A known BRCA1 or BRCA2 mutation in the family
If Your Family Health History of Breast Cancer is Average or Moderate Risk
Most women with a family health history of breast cancer don’t need genetic counseling for breast and ovarian cancer. Most women have family health histories that mean they are at average risk. Some women with breast cancer in their families will have a moderate risk.
If your family health history of breast cancer is average or moderate risk, you probably won’t need genetic counseling and testing for hereditary breast and ovarian cancer. One exception is if you have a moderate risk family health history and Ashkenazi or Eastern European Jewish ancestry. BRCA1 and BRCA2 mutations are more common in women of Ashkenazi or Eastern European Jewish ancestry. This means that women of Ashkenazi or Eastern European Jewish ancestry are more likely to have a BRCA1 or BRCA2 mutation than women of other ancestries with similar family health histories. Thus, a family health history that would be considered moderate risk for most women might be considered strong risk for you because of your Ashkenazi or Eastern European Jewish ancestry.
Even if your doctor doesn’t recommend genetic testing and counseling, your family health history of breast cancer can affect when you start mammography screening. If you are a woman with a parent, sibling, or child with breast cancer, you are at higher risk for breast cancer. Based on current recommendationsexternal icon, you should consider talking to your doctor about starting mammography screening in your 40s.
If your Family Health History of Breast or Ovarian Cancer is Strong Risk
If you are a woman with a strong risk family health history, you are more likely to have a mutation in BRCA1 or BRCA2 than women with average or moderate risk family health histories. Thus, you are more likely to benefit from genetic counseling and testing for mutations in BRCA1 and BRCA2. To learn more about risk for breast or ovarian cancer based on family health history, see family health history risk categories.
If You Have a Personal History of Breast or Ovarian Cancer
If you have a personal history of ovarian, fallopian tube, or primary peritoneal cancer, some current guidelines recommend that you have genetic counseling and testing. If you have a personal history of breast cancer, genetic counseling and testing may or may not be recommended for you, depending on your age of diagnosis, type of breast cancer, presence of certain other cancers or cancer in both breasts, ancestry, and family health history of breast, ovarian, and other cancers.
Learn more about genetic counseling for hereditary breast and ovarian cancer.
The BRCA1 and BRCA2 genes
The breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes are the genes most commonly affected in hereditary breast and ovarian cancer. Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But certain mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers. You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Because BRCA1 and BRCA2 mutations are inherited, family members with BRCA1 or BRCA2 mutations usually share the same mutation
