BRCA

Our approach

Discovering that you have a BRCA1 or BRCA2 genetic mutation can be a difficult time filled with uncertainty. It’s important to receive the right support from experts in genetics, which is why Northwell Health physicians will refer you to our Cancer Genetic Counseling Division. Here, you will meet with a genetic counselor to evaluate your family history, determine what tests to order and explain the results.

If you need additional support, we have a team ready, no matter the case. Specialists from our Division of Surgical Oncology, Gynecology Oncology Center and Breast Cancer Center have the experience and expertise to provide you with cutting-edge care.

Overview

BRCA (breast cancer gene) is a gene found in everyone. Its main function is to produce proteins that repair damage to your DNA, which helps your body naturally prevent cancer.

There are two types of the BRCA gene, BRCA1 and BRCA2. When one or both of these genes contains a mutation, they do not produce your cancer-preventing proteins properly. This puts you at a higher risk of developing breast cancer and gynecologic cancers, including ovarian, peritoneal and tubal cancer.

Though the BRCA1 and BRCA2 genes are very similar, they are associated with different levels of risk:

  • The BRCA1 mutation causes a higher risk for developing ovarian or tubal cancer than the BRCA2 mutation.
  • BRCA1 can also lead to the development of cancer at an earlier age, typically between the ages of 35 and 40. Cancer linked to the BRCA2 gene tends to develop a little later, between the ages of 45 and 50.
  • The BRCA1 mutation is overall riskier than the BRCA2 mutation; cancers linked to BRCA1 tend to be harder to treat and resistant to hormone therapies.

Mutations to the BRCA1 and BRCA2 genes are purely genetic and can be received from either of your parents. If your family has a history of cancers linked to the BRCA genes, your doctor may recommend a blood test to determine whether or not you carry the mutation.

Causes and risks

The cause of a BRCA gene mutation is genetic and can come from either your father or mother. You should tell your doctor if your family has a history of any of the following, as these factors may put you at an increased risk of inheriting the BRCA gene:

  • You or your family has a history of breast or gynecologic cancer, especially early onset breast or gynecologic cancers.
  • You or a family member has breast or gynecologic cancer, especially breast or gynecologic cancers that developed before the age of 50.
  • A family member had or has a known BRCA mutation.
  • You come from Ashkenazi Jewish ancestry.

Symptoms

Having a BRCA genetic mutation does not result in any symptoms by itself and cannot be discovered without genetic tests. If you know you are at risk of inheriting the mutation, have a conversation with your doctor as soon as possible. With early detection, our experts can get to work on developing an individualized plan to reduce your risk of developing cancer.

Diagnosis and testing

If it is determined that you are at risk for having the BRCA mutation, or you have breast or a gynecologic cancer, our gynecologic oncologists can perform a simple blood test to analyze your DNA for mutations.

The results can take up to a month and can be positive, negative or on some occasions, inconclusive. Regardless of the results, your specialist will recommend that you see a member of our genetic counseling team to interpret the test and your personal risk of developing cancer.

The results do not determine whether or not you have cancer, only whether or not you are at a higher risk of developing certain cancers.

Treatments

If it is determined you do have a harmful BRCA mutation, there are methods to reduce your chances of developing cancer. Your specialist will develop an approach tailored to your specific needs.

Women between the ages of 25 and 40 are typically offered chemoprevention. The most common form of chemoprevention, the birth control pill, has been shown to reduce the risk of ovarian cancer by 50 percent. In addition to chemoprevention, ultrasounds and other diagnostic tests should be performed regularly to monitor for any developments.

Women who have completed their childbearing or are over the age of 40 are offered risk-reducing minimally invasive surgery to remove the fallopian tubes, ovaries and any additional tissue at risk of developing cancer. Our gynecologic oncologists are experts in the field of robot-assisted and laparoscopic minimally invasive surgery and have extensive experience with these procedures. We also rigorously track outcomes to make sure we are offering care of the highest quality.

No matter the treatment plan, our team collaborates with the experts at the Northwell Health Cancer Institute to provide a holistic approach to every step of your care.