BRCA | Testing Positive

You have several options for managing your risk factors. The options you and your medical team choose will include variables other than being positive for BRCA mutations.

According to Facing Our Risks of Cancer Empowered (FORCE), options will fall into three categories:

  • Surveillance
  • Chemoprevention
  • Prophylactic Surgery

Surveillance, or expectant management, can include a number of steps would could help with early detection. While no medications or surgeries would be performed with this type of care, a variety of testing would need to be done on a regular basis. The following tests are recommended by the National Comprehensive Cancer Network:

  • Monthly breast self-exams beginning at age 18
  • Semiannual clinical breast exams beginning at age 25
  • Annual mammogram and/or MRI beginning at age 25 or 10 years early than the earliest age a family member was diagnosed with breast cancer
  • Semiannual transvaginal ultrasound preferably on the 1–10 days of the menstrual cycle by age 25, or 5–10 earlier than the earliest age a family member was diagnosed with ovarian cancer
  • Semiannual CA-125 preferably after day 5 of the menstrual cycle by age 30, or 5–10 years earlier than the earliest age a family was diagnosed with ovarian cancer.
  • Semiannual pelvic exam

Chemoprevention involves using medication to prevent or lower the risk of cancer in those without cancer. Keep in mind however, that there are risks involved. Work with your cancer specialist to determine which choice is right for you based on your particular situation. Options include the following:

  • Tamoxifen
  • Raloxifene
  • Aromatase Inhibitors
  • Nonsteroidal anti-inflammatory medications
  • Statins
  • Deslorelin
  • Fenretinide
  • Vitamin D

Prophylactic Surgery
Prophylactic surgery is the removal of healthy organs to prevent disease. For those who test positive for a BRCA mutation, prophylactic surgery could prevent cancer. When choosing this route, you must seek services from a highly skilled surgeon to maximize the chances of all of the cells being removed. Also be aware that this is an extreme choice with many physical and emotional ramifications; thus, before making a final decision about this treatment plan, you should seek counseling from professionals who specializes in prophylactic surgery for women at high risk for cancer. The surgeries you can consider are these:

  • Mastectomy
  • Oophorectomy
  • Salpingectomy
  • Hysterectomy

Whichever treatment path you choose, work with a knowledgeable physician and genetic counselor to stay up-to-date on research and treatment data. If you have a higher risk factor based on personal and family histories, your physician make also suggest other, more extensive testing. You may also want to consider participating in clinical trials for cancer prevention which might allow you to be part of cutting edge research and treatments. Joining a support group could also be helpful for your emotional health and for keeping you in touch with others dealing with similar risk factors so you can share news about treatment and prevention options.

Finally, you should also share your test results with family members so they can take proactive steps with their health too.

This content was written by staff of by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support. Reprinted with permission: BRCA | Testing Positive

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