Breast and ovarian cancer are topics of concern for all women - regardless of family history. Each year, close to 200,000 cases of breast cancer and about 25,000 cases of ovarian cancer are diagnosed. While the majority of breast and ovarian cancers are not caused by inherited risk factors, research has shown that about 10 percent of these cases are hereditary.  

Many people are unaware of their inherited risk, though they may be aware of a cancer history in their family. Whether or not you've had cancer, a family history of early onset breast and/or ovarian cancer at any age can point to the presence of hereditary cancer risk. Your risk for breast and ovarian cancer may also be heightened if you are of Ashkenazi or Eastern European Jewish heritage.

How is this risk inherited? We're all born with two copies of about 30,000 different genes, one copy of each gene from our mother and the other from our father. Two genes in particular, BRCA1 and BRCA2, normally work to prevent breast and ovarian cancer. But in some cases, we can inherit a BRCA1 or BRCA2 alteration from either parent. This alteration or mutation interferes with the normal activity of the gene, making us more susceptible to breast and ovarian cancer. A person with one of these gene mutations has a higher risk of developing these cancers and also may pass that gene mutation on to his or her children.

Here are some of the risk-reducing steps you and your doctor can take if your genetic test indicates a greater-than-average risk of developing an inherited cancer.

Increased Surveillance for Breast Cancer

• Monthly breast self-exams starting between ages 18-21
• Annual or semiannual clinical breast exams starting between ages 25-35
• Annual mammography starting between ages 25-35
• Consider investigational screening-for example: magnetic resonance imaging

Increased Surveillance for Ovarian Cancer

• Annual or semiannual transvaginal ultrasound (TVU) starting between ages 25-35
• Annual or semiannual check-up on serum CA-125 levels

Preventive Drug Therapies for Breast Cancer
Preventive drug therapies may be implemented along with increased surveillance. Specifically, tamoxifen, a selective estrogen receptor modulator (SERM), has been proven to cut in half the risk for women with BRCA mutations.

Preventive Drug Therapies for Ovarian Cancer
Oral contraceptives can reduce the chances of ovarian cancer in women with BRCA mutations, as well as the general population. Research has shown a risk reduction of up to 60 percent in women with BRCA mutations who took oral contraceptives.

Prophylactic Mastectomy
Prophylactic bilateral mastectomy has been shown to reduce breast cancer risk by greater than 90 percent in women with a BRCA mutation or a family history of the disease.

Prophylactic Oophorectomy
Prophylactic bilateral oophorectomy has been shown to reduce ovarian cancer risk by 96 percent in women with a BRCA mutation. It is generally recommended after 35 years of age or after childbearing is completed. If this procedure is performed pre-menopausally, it also reduces the risk of breast cancer by about 50 percent.

Q: How is the BRACAnalysis® test performed?
A: Your doctor draws a small amount of your blood or refers you to a blood draw facility and then sends it to Myriad Genetic Laboratories for analysis. This analysis involves a complex process called gene sequencing.

Q: How long does it take to get the test results from my BRACAnalysis® test?
A: Your doctor will share test results with you as soon as they are available, which can be as soon as four weeks from the date your test is started.

Q: Will my health insurance pay for the BRACAnalysis® test?
A: Most health insurance plans pay for BRACAnalysis®. Call the Myriad Reimbursement Assistance Program (MRAP) at 800-469-7423 for more details about the reimbursement process. MRAP can also assist you with determining coverage through your insurance company.

Q: Can my health insurance provider discriminate against me based on my BRACAnalysis® test results?
A: A number of federal and state laws prohibit insurance discrimination to various degrees. The Health Insurance Portability Protection Act (HIPAA) recognizes genetic information as Protected Health Information (PHI) and specifies protection for the confidentiality of PHI. HIPAA also provides restrictions on health-related information in making coverage decisions and in setting premiums by group health insurers, although HIPAA does not provide such restrictions for non-group plans. HIPAA further states that genetic information in the absence of a diagnosis cannot be considered a pre-existing condition. In the federal government, executive departments and agencies are prohibited by executive order from using protected genetic information as a basis for employment decisions. The Equal Employment Opportunity Commission has interpreted the Americans with Disabilities act to provide some additional protections from the use of genetic information by employers. Many states have enacted additional protections against genetic discrimination in health insurance or employment or both. The Genetic Information Nondiscrimination Act is currently awaiting final approval in the US Senate, to complete broad protection of genetic information.

Q: If I take the BRACAnalysis® test and my results are positive for a BRCA gene mutation, what are my options for reducing my risk of cancer?
A: You and your doctor would have a number of options to discuss based on your test results. One option involves the use of prescription drugs such as tamoxifen to reduce the risk of breast cancer or oral contraceptives to reduce the risk of ovarian cancer. Other options include increased surveillance and preventive surgery.

Q: If I've already had breast cancer, what would a positive BRACAnalysis® result mean?
A: People with a BRCA gene mutation are at a greater risk of developing a new cancer, either in the ovaries or the breast. Knowing your BRCA status can help you take steps to reduce this risk or detect another potential cancer at an early, more treatable stage.

Q: Does a positive BRACAnalysis® test result mean that I currently have cancer - for example, a tumor that wasn't previously diagnosed?
A: BRACAnalysis® does not determine or confirm if you currently have cancer. Your results provide information about your inherited risk of breast and ovarian cancer.

Q: If no one in my family has had ovarian cancer, do I still have to worry about this particular kind of cancer if I'm found to have a BRCA1 or BRCA2 mutation?
A: A woman who carries a BRCA1 or BRCA2 mutation is at an increased risk for both breast and ovarian cancer, even if there are no known cases of ovarian cancer in the family.

Q: Is BRACAnalysis® appropriate for men as well?
A: If a man has a personal history of breast cancer or a significant family history of breast or ovarian cancer, he may have a BRCA1 or BRCA2 mutation. Also, if a family member has a BRCA1 or BRCA2 mutation, he may also have inherited that mutation. Men in these circumstances should consider testing. Although male breast cancer is rare, men who carry BRCA mutations are more likely to develop breast cancer, as well as prostate cancer. Men with a BRCA mutation also have a 50 percent chance of passing it on to their children, whether or not they've been diagnosed with cancer.