Hereditary cancers are different from sporadic cancers in ways that could effect treatment choices. Anyone who is diagnosed with cancer and who has a family history of cancer or meetsnational guidelines for genetic evaluation should consult with a genetics expert soon after diagnosis. If you are concerned that the cancer in your family is hereditary and you have not been referred for genetic counseling, visit our section on finding a genetics expert.
Some treatment decisions that may be influenced by genetic test results include:
• Participation in treatment clinical trials
Some research studies are looking at targeted therapies to specifically treat or prevent hereditary cancers. The best time to look into participating in clinical trials is when you are first diagnosed with cancer or a recurrence and before starting treatment. Some studies have restrictions on the number or the types of prior cancer treatments that a person has received. See our clinical trials page for research on PARP inhibitors and other studies specifically designed for people with BRCA mutations or hereditary cancers.
• Choice of surgery
Because of the very high risk for a second (or third) breast cancer diagnosis, some women who are diagnosed with hereditary breast cancer choose bilateral mastectomy (surgical removal of both breasts) rather than undergoing lumpectomy and radiation. Studies have shown similar survival rates for women with BRCA mutations who undergo lumpectomy and radiation and women who undergo mastectomy. However, mutation carriers who undergo mastectomy are less likely to develop a second breast cancer.
• Oophorectomy vs. medication to induce menopause
BRCA carriers are at increased risk for ovarian cancer. In women with estrogen receptor-positive breast cancer, treatment often involves injections to shut down the ovaries' production of estrogen. For BRCA carriers who are at increased risk for ovarian cancer, another option may be oophorectomy, which removes the ovaries to lower the risk for ovarian cancer. Further, oophorectomy has also been shown to lower the risk for primary breast cancers in BRCA carriers who do not have bilateral mastectomies.
• Tamoxifen, aromatase inhibitors or other hormonal therapies
Tamoxifen is a treatment used for estrogen receptor-positive breast cancer. Aromatase inhibitors are medications that are prescribed for some post-menopausal women to reduce estrogen production by their fat cells and adrenal glands. These drugs are used for preventing breast cancer recurrence in women with cancers that are estrogen or hormone-receptor positive. Research on these drugs suggests that they lower the risk for future breast cancers in women who have already been diagnosed. However, very little research has been done with either type of drug specifically on women with BRCA mutations. For more information, see our section on tamoxifen and our section on aromatase inhibitors.
• Use of chemotherapy agents
Some research studies show that women with BRCA 1 mutations tend to develop more aggressive breast cancer than women with sporadic cancer. A small study suggested that women with BRCA 1 mutations who received any chemotherapy had better outcomes than women who did not receive chemotherapy. Researchers are studying whether certain types of chemotherapy work better than others for mutation carriers. At this time, most oncologists do not feel there is enough evidence to choose the type of chemotherapy based on a BRCA test result.
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