If you are a young women who is at high risk for developing breast and ovarian cancer, there are several options for you. What is right for one person may not be right for another; therefore it is important to discus your options with a team of trained professionals overseeing your health care who are familiar with the standards of care and risk management in high-risk women, which may include but not be limited to your breast cancer surgeon, internal medicine physician, genetics counselor, psychologist, gynecologist and oncologist.

While none of the following surveillance or screening methods below can prevent cancer, catching it early can greatly improve one’s odds of survival. The following tests and procedures are available and often aid in the detection of both breast and ovarian cancer. For more information on surveillance recommendations for the general population as well as those who are at high risk for developing breast and ovarian cancer click here (link to Early Detection and Screening)

Surveillance Program
If cancer develops, it is essential to catch it as early as possible to insure successful treatment. Several hospitals (especially those affiliated with major universities) have surveillance programs for young women at risk. At many of these programs, young women are given a yearly mammogram, as well as an ultrasound, MRI and clinical breast exam every six months. In fact, recently the American Cancer Society issued a statment that young women who are at high risk should receive an MRI yearly beginning at age 30. Studies are currently being conducted to test the effectiveness of other breast cancer screening techniques as well.

In regard to ovarian cancer, current surveillance methods include transvaginal ultrasound, CA-125 blood testing and clinical exams. However, these surveillance methods are not as advanced in early detection in all cases.

MRI
Magnetic Resonance Imaging (MRI) is a test that uses magnetic fields to create an image of the breast that can be meticulously examined for abnormalities. A mammography and MRI combination has been shown to increase the detection rate of breast cancer in women who are at high risk due to the BRCA1 or BRCA2 gene mutation or a family history of breast cancer. While mammograms are thought to be less effective in younger women because their breast tissue is denser and making the images harder to read, there is no conclusive data to suggest that young women should get MRI’s in place of mammograms, but rather, in addition to them. MRI tests in combination with a mammography is specifically suggested annually to women who:

• Are carriers of the BRCA1 or BRCA2 gene mutations
• Have first-degree relatives that are BRCA1 or BRCA2 carriers but have not been tested yet
• Have a strong family history of breast or ovarian cancer (2 or more first-degree relatives who had breast/ovarian cancer)
• Received radiation to the chest between ages 10-30 years
• Women with Li-Fraumeni syndrome, Cowden, or Bannayan-Riley-Ruvalcaba syndromes and their first-degree relatives
• Have a 20.1-25 percent greater than average risk of invasive breast cancer

Prophylactic (Preventative) Surgery
This surgery involves removal of tissue at-risk to reduce the likelihood of developing cancer. Preventive mastectomy (removal of healthy breast tissue) and preventive salpingo-oophorectomy (removal of healthy fallopian tubes and ovaries) do not offer a guarantee against developing these types of cancer as it is impossible to remove every piece of tissue. There is no way to know ahead of time how this surgery will affect a particular woman. Some women with BRCA mutations or who are very high risk will develop a fatal breast cancer early in life, and a prophylactic mastectomy before the cancer occurs might add many years to their life expectancy. Although most women with BRCA mutations develop breast cancer, some don’t and these women would not benefit from the surgery. All insurance do not cover this procedure. However, by working with your physicians and a genetic counselors, there is a better likelihood of getting the surgery covered by an insurance company.

Healthy Habits
You can help decrease your breast caner risk by implementing healthy habits into your life such as exercising regularly, maintaining an appropriate weight and limiting alcohol consumption. Research regarding maintaining healthy habits by BRCA1 and BRCA2 carriers or those who are at significantly higher risk are yet unknown. Also see Lifestyle Related Factors you may have some control over.

Chemoprevention
This option involves the use of natural or synthetic substances to reduce the risk of developing cancer or reduce a reoccurrence. The National Cancer Institute-supported Breast Cancer Prevention Trial found that the drug "tamoxifen" reduced the risk of invasive breast cancer in women with an increased risk. One study found that tamoxifen did reduce the incidence of breast cancer by 62% in women with a BRCA2 gene mutation; however, there was no reduction in those women with a BRCA1 gene mutation. There are very few studies testing the effectiveness of "tamoxifen" in women with a BRCA1 or BRCA2 gene mutation but additional studies with these types of substance are anticipated.

Gene Therapy
Currently, mutations in BRCA1 and BRCA2 cannot be repaired. In the future, it may be possible to repair or manipulate these genes to decrease one’s risk of developing cancer.

Sources: National Cancer Institute, 2007; Susan G. Komen for the Cure, 2007; American Cancer Society, 2007.