Treatment decisions for people with hereditary breast cancer
Hereditary cancers are different than sporadic cancers in ways that can affect treatment choices. Some treatment decisions that may be influenced by genetic test results are listed below. If you are concerned that your cancer may be caused by an inherited mutation, you should contact a genetics expert to see if genetic testing is right for you.
- Choice of breast surgery: Because of the very high risk for a second (or third) breast cancer diagnosis, women who are diagnosed with breast cancer who test positive for an inherited mutation often choose bilateral mastectomy (surgical removal of both breasts) rather than lumpectomy and radiation. Mutation carriers who undergo mastectomy are less likely to develop a second breast cancer since the at-risk breast tissue has been removed. Our mastectomy section provides more information about surgical options.
- Participation in treatment clinical trials: Some research studies are exploring targeted therapies specifically to treat or prevent hereditary cancers. If you are interested in the possibility of participating in a clinical trial, it is best to express your interest when you are first diagnosed or have a recurrence and before you start treatment. Some studies have restrictions on the number or types of cancer treatments previously received by trial participants. Our clinical trials page provides information about research on PARP inhibitors and other studies specifically designed for those with BRCA mutations or hereditary cancers.
- Oophorectomy vs. medication to induce menopause: BRCA mutation carriers are at increased risk for ovarian cancer. In young women with ER-positive breast cancer, treatment sometimes includes injections to shut down the ovaries' production of estrogen. Another option may be an oophorectomy (surgical removal of the ovaries), which lowers the risk for ovarian cancer. Oophorectomy by age 40 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 drug used to treat ER-positive breast cancer. Aromatase inhibitors are drugs prescribed to post-menopausal women with breast cancer to reduce estrogen production by their fat cells and adrenal glands. These drugs are used to help prevent breast cancer recurrence in women with ER-positive or hormone-receptor positive cancers. Research on these drugs suggests that they not only lower the risk for subsequent breast cancers in women who have already been diagnosed, but also in those at risk who have not ever been diagnosed with breast cancer.
- Use of chemotherapy agents:
Some research studies show that women with BRCA1 mutations tend to develop more aggressive breast cancers than those in women who develop sporadic breast cancer. A small study suggests that women with BRCA1 mutations who received any chemotherapy had better outcomes than women who did not receive chemotherapy. Other research suggests that BRCA-positive individuals diagnosed with triple-negative breast cancer may respond particularly well to platinum-based chemotherapy.
If you are a breast cancer survivor making decisions about genetic testing can be confusing and you may want additional guidance or support. FORCE's Peer Navigation Program provides expert reviewed resources and 1:1 personalized peer support by specially trained volunteers who have experienced the very challenges you face.