Cancer is a complex disease with many contributing causes, including hereditary factors. Women with a BRCA mutation have an elevated risk for breast and/or ovarian cancer. Some women who have a personal or family history indicative of a hereditary cancer syndrome who have not tested positive for a BRCA mutation may still have an elevated risk for these cancers. Experts use research on families with hereditary cancer to estimate the risk in people with BRCA mutations. Not all research has shown the same lifetime risk for cancer, even in two people with the same mutation. There are many reasons why risks for breast and ovarian cancer may differ. Varying factors such as environment, reproductive history, exercise level and body weight may effect who develops cancer and at what age. Many people base their risk-management decisions on their level of risk; a difference between a lifetime risk for breast cancer of 85% vs. 45% may alter their risk-management choices. Unfortunately, it is difficult to calculate a person’s exact risk of developing cancer in her lifetime. Nor can experts predict at what age someone might develop cancer.

Because of this uncertainty, most experts calculate an estimated “risk range” rather than a specific percentage when citing cancer risks related to a BRCA mutation or a strong family history of cancer. As researchers learn more about hereditary cancers, our understanding about why some people develop cancer at a younger age will improve, and so will our ability to assess cancer risk more accurately. To determine your risk for cancer and identify your risk management options, consult with experts in cancer genetics. They will provide the most current personalized information about cancer risk and management.

Breast cancer
Every woman is at risk for breast cancer and her risk increases with age. A woman in the general population faces about a 13% lifetime risk of developing breast cancer. This risk remains low before age 50; the majority of risk occurs after age 60. Women with a BRCA1 or BRCA2 mutation have a much higher lifetime risk for breast cancer, and much of the risk occurs at a younger age. However, experts don’t agree on the exact lifetime risk figures for women with either mutation because different studies of families with BRCA mutations identified different lifetime risks.

An October 2003 study of women carrying one of the three BRCA1 or BRCA2 mutations common in Jewish populations indicated a lifetime breast cancer risk of about 85%. This poster shows a decade-by-decade breakdown for breast cancer risk in BRCA carriers compared to the general population according to this study. The same study found BRCA mutation carriers born after 1940 have a higher lifetime risk for breast cancer than women born before 1940. Factors including lifestyle (diet, weight, and exercise), reproductive choices (number of pregnancies and age at the time of pregnancies) and exposure to certain viruses or chemicals may account for these differences. Different research involving many families with BRCA mutations (not specifically Jewish families) showed a comparatively lower breast cancer risk in women with BRCA mutations: 65% by age 70 for women with a BRCA1 mutation and 45% by age 70 for women with a BRCA2 mutation.

Women with BRCA mutations who have no family history of breast cancer are still at increased risk for the disease. Their risk is believed to be comparable to families with a history of breast cancer and the same mutation.

Predicting breast cancer risk is even more difficult in families with a strong history of breast or ovarian cancer but no BRCA mutation. It is important for women in these families to consult with a cancer genetics expert. Researchers are looking for other hereditary cancer causes in these families. Visit our page on research to determine whether your family qualifies for a study to identify cancer risk.

Confronting your personal cancer risk can be confusing and frustrating. If you are a high-risk woman trying to choose the best risk-management option, you need as much information about your personal risk as possible. Sometimes it helps to speak with other women who have faced these choices. Learn more about talking with other high-risk women in our support section of the website. As new research continues, the ability of medical experts to predict breast cancer risk will improve. Therefore it is important to consult with a specialist in cancer genetics when determining your risk for breast cancer and making risk-management decisions that are best for you. Stay in contact with a genetics expert for updates on current knowledge.

Risk for a second breast cancer
Women with a BRCA mutation, who choose breast conservation to treat their breast cancer are at higher risk for another cancer in either breast than a woman with sporadic breast cancer. Although exact risk depends on a woman’s age and other factors, one study found BRCA carriers diagnosed with breast cancer have a 14% chance within ten years of developing the disease in the same breast, and a 37% chance within ten years of developing the disease in the opposite breast. Another study found a 40% chance for BRCA carriers to develop cancer in the opposite breast as well within 10 years of their initial diagnosis. The risk for a second breast cancer among women who develop sporadic cancer is about 10%.

Ovarian cancer
Every woman is at some risk for ovarian cancer and her risk increases with age. The lifetime risk for ovarian cancer for the female general population is about 1.5%. That risk is much higher and occurs at a slightly younger age for women with BRCA1 or BRCA2 mutations. Experts don’t agree on the exact lifetime risk figures for women with either mutation because different studies on families with BRCA mutations have shown different lifetime risks for ovarian cancer. An October 2003 study of women with one of the three BRCA1 or BRCA2 mutations common in Jewish populations indicated a lifetime ovarian cancer risk of 54% in women with BRCA1 mutations and 23% in women with BRCA2 mutations. This poster shows the study’s decade-by-decade breakdown for ovarian cancer risk in BRCA carriers compared to the general population. A different study of multiple families with BRCA mutations (not specifically Jewish families) found a comparatively lower risk: 39% for BRCA1 carriers, compared to 11% of BRCA2 carriers by age 70. Both studies show the risk for ovarian cancer in BRCA carriers begins after the age 30, and most of the risk occurs after age 40. A recent study suggests that much of the ovarian cancer in BRCA carriers may begin in the fallopian tubes. See our section on fallopian tube cancer and our section on prophylactic oophorectomy for more information on fallopian tube cancer.

Women with BRCA mutations but with no family history of ovarian cancer are still at increased risk for the disease. Their risk is believed to be comparable to other families with the same mutation and a history of ovarian cancer.

Predicting ovarian cancer risk is even more difficult in families with a strong history of breast or ovarian cancer but no BRCA mutation. It is important for women in these families to consult with a cancer genetics expert. Researchers are looking for other hereditary cancer causes in these families. Visit our page on research to determine whether your family qualifies for a study to identify cancer risk.

Confronting your personal risk can be confusing and frustrating. If you are a high-risk woman trying to choose the best risk-management option, you need as much information about your personal risk as possible. Sometimes it helps to speak with other women who have faced these choices. Learn more about talking with other high-risk women in our support section of the website. As new research continues, the ability of medical experts to predict ovarian cancer risk will improve. Therefore it is important to consult with a specialist in cancer genetics when determining your risk for ovarian cancer and making risk-management decisions that are best for you. Stay in contact with a genetics expert for updates on current knowledge.

Ovarian cancer risk after breast cancer
Breast cancer survivors who have a BRCA mutation or hereditary breast cancer are at higher risk for ovarian cancer than breast cancer survivors with sporadic breast cancer. A research study on ovarian cancer risk in breast cancer survivors with a BRCA mutation found a 12.7% risk in BRCA1 carriers and 6.8% risk in BRCA2 carriers within 10 years of the breast cancer diagnosis. Women with a family history of breast and ovarian cancer but no identified BRCA mutation have an elevated risk of ovarian cancer after breast cancer, but the exact risk is unknown. Genetic experts can help breast cancer survivors who have a BRCA mutation, a family history of cancer, or other indicators of hereditary cancer determine their risk for ovarian cancer and develop a risk management plan.

Breast cancer risk after ovarian cancer
Ovarian cancer survivors who have a BRCA mutation are at higher risk for breast cancer than women with sporadic ovarian cancer. The exact risk for breast cancer after ovarian cancer is unknown, but may depend on a number of factors. Genetic experts can help ovarian cancer survivors with a BRCA mutation, a family history of cancer, or other indicators of hereditary cancer determine their risk for breast cancer and develop a risk management plan.

Male breast cancer
Anyone, male or female can get breast cancer, but generally, men are much less likely to develop the disease than women. Men who carry a BRCA mutation have a higher risk for breast cancer than men in the general population. However, the risk is still fairly low. Several small studies have determined the lifetime risk for breast cancer to be about 6% in men with BRCA1 mutations and about 7% in men with BRCA2 mutations.