Thinking about cancer or dealing with cancer risk can be scary or overwhelming, but we believe that receiving information and resources is comforting, empowering, and lifesaving.
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 meets national 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:
Treatment for advanced ovarian cancer
There are two FDA approved drugs for some women with hereditary ovarian cancer. Lynparza (also known as olaparib) is approved to treat ovarian, fallopian tube, and primary peritoneal cancer in women who carry mutations in BRCA1 or BRCA2, and who have received three or more chemotherapy treatments. Rubraca (also known as rucaparib) is approved to treat women with advanced ovarian cancer who have had two or more prior treatment and who have inherited mutations in BRCA or whose tumors have BRCA mutations as detected by the FoundationFocus CDxBRCA companion diagnostic.
Choice of breast 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. Visit our mastectomy section for more information on surgery.
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 other hereditary cancers.
Oophorectomy vs. medication to induce menopause
Women with mutations in BRCA, BRIP1, RAD51C or RAD51D are at increased risk for ovarian cancer. In young women with estrogen receptor-positive breast cancer, treatment sometimes involves injections to shut down the ovaries' production of estrogen. For women with inherited mutations who are at increased risk for ovarian cancer, another option may be oophorectomy, which removes the ovaries to lower the risk for ovarian cancer. Oophorectomy has also been shown to lower the risk for new breast cancers in BRCA carriers who have 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.
Use of chemotherapy agents
Some research studies show that women with BRCA1 mutations tend to develop more aggressive breast cancer than women with sporadic cancer. A small study suggested that women with BRCA1 mutations who received any chemotherapy had better outcomes than women who did not receive chemotherapy. Other research suggests that people diagnosed with triple negative breast cancer who have a BRCA mutation may respond particularly well to platinum chemotherapy.