Breast cancer is the most common cancer in the UK and accounts for 15% of all new cancer cases. It is the most common cancer to affect women with 1 in 7 women being diagnosed resulting in approximately 55,000 new cases per year. Breast cancer can occur in men as well, but it is much rarer, with only around 400 new cases per year. Breast cancer can occur at any age, but most cases are seen in women over the age of 50.
There are many risk factors which may increase the chances of developing breast cancer: age, ethnicity, being overweight, certain medications, previous history of cancer or a family history of breast cancer.
Some people may have a higher risk of developing breast cancer than the average population due to a family history of the disease. Having a first degree relative (mother, sister, or daughter) with breast cancer can potentially double your risk of developing it. However, it is important to note that we are talking about risk of developing breast cancer. This is never a certainty. Many women who have a close relative with breast cancer will never develop it.
Current UK guidelines state that your GP will refer you to a specialist breast clinic for assessment if you have:
One first degree female relative with breast cancer aged 40 or below
One first degree male relative diagnosed with breast cancer at any age
Multiple family members diagnosed with breast cancer at any age
There are some further criteria that can be found on the Cancer Research UK website.
In some cases where there is a very strong family history of breast cancer, your doctors may wish to explore your genetic risk of developing it. Sometimes there can be faulty genes within your DNA that increase your risk of developing breast cancer. These genes may also increase your risk of developing other cancers, such as ovarian cancer. Through research, we now know of several such gene mutations which may increase cancer risk.
The most common ones that are spoken about are the BRCA1 and BRCA2 genes. Everyone has the BRCA1 and BRCA2 genes within their DNA. These genes are involved in keeping our bodies in check and stopping our cells from growing and dividing out of control. Cancer develops when our cells divide and multiply abnormally and spread into surrounding tissue. BRCA1 and BRCA2 stop this from happening. If there is a fault or mutation within these 2 genes, then it may increase your risk of cancer by up to 80%. It is estimated that only about 0.25% or 1 in every 400 people carry the BRCA mutations.
There are several other genes that can also increase the risk of breast cancer but BRCA1 and BRCA2 are the most common ones.
Having a fault or mutation in any one of these genes will increase your risk of breast cancer, ovarian cancer and other cancers compared with someone who does not carry the same mutation or fault. However, please remember that only 5-10% of breast cancers are caused by an inherited faulty gene or mutation.
It is important to discuss any concerns or worries with a medical professional who will be able to guide you and help alleviate any concerns. Your GP will be able to listen to your worries, answer any queries and provide you with all the relevant information. If your doctor believes that based on your family history, you are eligible for genetic testing, then you may be referred for genetic counselling. This is a specialist service where you can speak to a doctor or healthcare professional who specialises in genetics. They can help to determine the best course of action for you. Genetic tests for these mutations often look for one gene at a time so you may need more than one test. Your doctor or healthcare professional will be able to further advise you.
Genetic testing itself only involves taking a small sample of blood or saliva, which is then sent to a genetic laboratory for testing and analysis. Results can take anywhere between a few weeks and a few months depending on which test you are having done.
The genetic counsellor will most likely see you again after the genetic results to discuss what they mean. They will answer any questions you have about what the results are, what they mean and how they will impact you. If there are any decisions to be made, the counsellor will help you to navigate those decisions and ensure you have all the relevant information.
Genetic testing is often very scary. There are many emotions and decisions that go hand in hand with a positive genetic result. You may feel scared, angry, sad, or guilty. It is important to remember that these are normal emotions and are to be expected. It is important to talk through these emotions and seek help and support wherever necessary.
The results can also affect other family members such as siblings and children. If someone tests positive for a genetic mutation, then it means their siblings have a 50% chance of also having that mutation. The genetic counsellor will advise on how and when to have these discussions with your family members.
The results can also impact you and your life. According to current NHS guidelines, for women who test positive for the BRCA1 or BRCA2 mutations, bilateral mastectomies are recommended to lower their risk of developing cancer. Your doctor will explain all the benefits and risks and give you the latest information to help you make this decision. These decisions are often extremely hard, and you may wish to have some counselling to help you make this decision and manage your feelings.
Women with an increased risk of developing breast cancer will also be referred for more regular screening programs. This may involve being referred for screening at a younger age and having regular breast exams, mammograms, and MRI scans.
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