Your risk of breast cancer
The risk of developing breast cancer in someone’s lifetime if they don’t have a gene variant is around 14 per cent (14 in 100 chance).
If you have a BRCA1, BRCA2 or PALB2 gene variant, you have a very high risk of developing breast cancer in your lifetime:
BRCA1 gene variant – around 72 per cent (72 in 100 chance).
BRCA2 gene variant – around 69 per cent (69 in 100 chance).
PALB2 gene variant – around 53 per cent (53 in 100 chance).
If you have a RAD51C or RAD51D gene variant, your risk of developing breast cancer during your lifetime increases slightly to around 20 per cent (20 in 100 chance).
If you have had surgery to remove your breasts or ovaries, your risk is lower, but a small risk remains.
An increased risk of breast cancer doesn’t mean you will definitely develop breast cancer. Breast Cancer Now has more information about gene variants that increase the chance of developing breast cancer.
- Who can develop breast cancer?
Anyone born with breast tissue is at risk of developing breast cancer. This means most women and trans men, some non-binary people, and some people who have differences in sex development are at risk of breast cancer. If you have had your breast tissue removed, you’re at lower risk, but a small risk still remains. Trans women are also at risk if they have had hormone treatment.
Men can develop male breast cancer, but it’s rare. They have a lifetime risk of breast cancer of around 0.1 per cent (0.1 in 100 chance). Men with a BRCA1 or BRCA2 variant have a small risk of developing male breast cancer of:
Your risk of pancreatic cancer
For the general population, the lifetime risk of developing pancreatic cancer is up to 1 per cent (1 in 100 chance) for women, trans men, non-binary people with ovaries, fallopian tubes or a womb and some people with differences in sex development.
If you have a BRCA2 or PALB2 gene variant, your risk of developing pancreatic cancer in your lifetime increases slightly to around 2 per cent (2 in 100 chance). If you have a variant in your BRCA1 gene, you don’t have a significant increased risk of developing pancreatic cancer.
- Male risk of pancreatic cancer
Men, trans women, non-binary people with a prostate, and some people with differences in sex development in the general population have a lifetime risk of pancreatic cancer of around 1 per cent (1 in 100 chance).
If they have a BRCA1, BRCA2 or PALB2 variant, they have a small increased risk of developing pancreatic cancer in their lifetime of:
- Your risk of other cancers
If you have a variant in the genes MLH1, MSH2 or MSH6, you may have Lynch syndrome and an increased risk of developing other cancers. Macmillan has more information about the increased risk of developing cancer with Lynch syndrome.
- Male risk of prostate cancer with a BRCA2 gene variant
Men, trans women, non-binary people with a prostate, and some people with differences in sex development in the general population have a lifetime risk of prostate cancer of around 12 per cent (12 in 100 chance).
With a BRCA2 variant they have a 27 per cent (27 in 100 chance) of developing prostate cancer across their lifetime.
Evidence for an increased risk of prostate cancer with a BRCA1 variant is unclear. Some evidence suggests that there’s an increased risk of 17 per cent (17 in 100 chance) while more recent evidence suggests there’s no increased risk.
Managing your increased risk of breast cancer
If you have a variant in your BRCA1, BRCA2 or PALB2 gene, you’re at very high risk of developing breast cancer. A genetic counsellor will tell you about the different ways to reduce your risk of developing breast cancer. The options include:
breast screening, also called surveillance
risk-reducing surgery (removal of both breasts)
drug treatment, called medical prevention
you will also be given advice on other options and lifestyle changes to reduce your risk.
Before deciding, think about your current health and predictions of whether the ovarian cancer might grow or change. You may also be referred to a family history breast cancer clinic where specialists in this area will take over your care.
Breast screening
Breast screening looks for cancer that’s too small to see or feel. Screening is done by:
- mammogram – an X-ray of your breasts
- magnetic resonance imaging (MRI) – a type of scan that uses strong magnetic fields and radio waves to see inside the body.
Breast screening won’t stop breast cancer developing. But it will help find cancers at an early stage when they’re easier to treat.
The NHS runs a national breast screening programme. Anyone registered as female with their GP surgery and living in the UK is invited for their first breast screening between the ages of 50 and 53. Breast screening continues every three years until you turn 71. Anyone can ask to continue breast screening every three years from age 71 or over.
If you have a BRCA1, BRCA2 or PALB2 gene variant, you can start breast screening before the age of 50. You may be offered a yearly mammogram and/or MRI from the age of 25 or older. If you have a RAD51C or RAD51D gene variant, you may be able to start breast screening earlier as well.
When you start breast screening depends on how high your individual risk of developing breast cancer is. If you have a gene variant, speak to your treatment team or clinical genetics team to find out when you can start breast screening.
- Breast screening if you're transgender or non-binary
If you're a trans man, trans woman or are non-binary, how you’re invited for breast screening will depend on the sex you’re registered as at your GP surgery:
If you're registered as female, you will automatically be invited for breast screening.
If you’re registered as male, you won’t automatically be invited.
If you were assigned female at birth and you haven’t had top surgery, you can have breast screening. Top surgery is removing the breasts and having male chest reconstruction.
If you were assigned male at birth and you have been taking the feminising hormone oestrogen for longer than two years you can have breast screening. This is because taking oestrogen increases your chance of getting breast cancer.
If you think you should have breast screening but you’re not invited automatically, contact your GP surgery. You can also contact your local breast screening service to ask for an appointment.
Risk-reducing surgery for breast cancer
Risk-reducing surgery is an operation to remove both of your breasts. You may also hear it called a bilateral mastectomy.
If you’re at very high risk of developing breast cancer due to a variant in the BRCA1, BRCA2 or PALB2 genes, you may be offered the option of risk-reducing surgery.
Risk-reducing breast surgery can’t guarantee that you won’t develop breast cancer. But the risk afterwards is small enough that breast screening isn‘t needed.
As there is a small amount of breast tissue remaining, you should check your breast area regularly to look for any changes.
It’s likely that you’ll be offered the option of having reconstructive surgery. This is an operation to rebuild both breasts using implants and/or tissue from another part of your body. This may be carried out at the same time as the natural breast tissue is removed. Or it may be done at another time as a separate surgery. Speak to your treatment team about options for this surgery. They may recommend that you don’t have it until after you have recovered from your ovarian cancer treatment.
Surgery will have an impact on you both physically and emotionally, especially following an ovarian cancer diagnosis. You will be referred to a genetic counsellor and psychological counsellor if you’re deciding whether to have risk-reducing surgery. It’s important that you take your time when making this decision. Talk to them and your treatment team about all the advantages and disadvantages before you decide.
The genetics team spoke to me about the options to have my breasts removed. I’d just had surgery for ovarian cancer and still had no hair from chemotherapy. At that point it just felt too soon for me. I couldn’t bear the thought of more scarring and more surgery.
If there wasn’t a chance that the ovarian cancer could come back, I would be more likely to have my breasts removed. It’s a really tough decision. I have a yearly MRI and mammogram. I do feel better that my risk of breast cancer is monitored.
Jayne
Medical prevention
If you’re at moderate to high risk of developing breast cancer you may be offered medical prevention drugs to try to reduce your risk of breast cancer developing. You may also hear it called chemoprevention. Medical prevention is treatment with drugs such as:
tamoxifen
anastrozole
raloxifene.
Tamoxifen and anastrozole are usually used as treatments for breast cancer. Raloxifene is used to treat or prevent osteoporosis (bone thinning) after the menopause. The drugs can also be used to delay breast cancer coming back (recurring).
Before you decide whether to take medical prevention drugs, your treatment team will give you written information and speak to you about:
Speak to your clinical geneticist, genetics counsellor or a breast cancer specialist if you have any questions.
Lifestyle changes
If you have a gene variant that increases your risk of developing breast cancer you will be given advice about other factors which may affect your risk. These include:
- Taking an oral contraceptive pill
This is a type of hormonal contraceptive, which can increase the risk of breast cancer. If you stop taking the pill, this increased risk of breast cancer gradually reduces again.
- Taking hormone replacement therapy (HRT)
This is a treatment to help menopause symptoms. Depending on your situation it may increase your risk of developing breast cancer. Your clinician should talk to you about whether the increased risk outweighs the benefit. They can also tell you what alternatives there are.
- Other lifestyle changes to reduce your risk
These include:
