The common connection between Breast Cancer and Ovarian Cancer is that both of these may be hereditary, occurring due to mutations in the BRCA1 and BRCA2 genes. These genes are generally involved with cell growth and DNA repair. Hence, a mutation in these genes might impede their ability to control cell growth, thus leading to cancer in the Breasts or Ovaries.
Inheritance and risk factors
Both men and women can carry mutations of the BRCA genes, and they have a 50% chance of passing it on to their children. On an average, approximately 1 in 400 to 1 in 800 people carry mutations of the BRCA genes.
The risk of developing breast cancer during one’s life as a result of the BRCA faulty genes is between 45% and 90%, whereas the risk of developing ovarian cancer as a result of these faulty genes is between 39% to 46% in BRCA1 and 10% to 27% in BRCA2.
Genes
The faulty genes which most significantly increase Breast and Ovarian cancer risk are:
• BRCA1
• BRCA2
The following are the changes in some genes which are not as dire as the BRCA genes, but still slightly increase the chance of breast or ovarian cancer:
• BRIP1
• ATM
• CDH1
• CHEK2
• MRE11A
• NBN
• PALB2
• PTEN
• RAD50
• RAD51C
• STK11
• TP53
Syndrome
Hereditary Breast and Ovarian Cancer Syndrome (HBOC) is the presence of an inherited gene mutation which increases the risk of Breast or Ovarian cancers, or both. HBOC syndrome is mostly caused by mutations in either BRCA1 or BRCA2 genes.
Several factors need to be considered when determining whether HBOC might run in a family. These factors include:
• How many women in the family have been diagnosed with cancer before the age of 45.
• How many women in the family have been diagnosed with breast or ovarian cancer before the age of 50, with an additional family history of other cancers.
• Whether Breast and/or Ovarian cancer has been diagnosed in women on the same side of the family through several generations.
• Whether a woman in the family has been diagnosed with breast cancer more than once either on different breasts or on different parts of the same breast.
• Whether a woman in the family has been diagnosed with both breast and ovarian cancer.
• Whether a male relative on the same side of the family has been diagnosed with breast cancer.
• Whether the family shares an Ashkenazi Jewish ancestry with a history of breast and/or ovarian cancer.
Prevention and Risk Reduction
Cancer Prevention is the action or actions which are taken to lower the chance of getting cancer significantly. In order to determine the means to prevent cancer, scientists generally study the risk factors and protective factors. Risk factors increase the chance of developing cancer whereas protective factors lower them.
Risk factors such as smoking and drinking can be avoided, however some of the more pernicious risk factors like faulty genes cannot be avoided. As such, if you have the Hereditary Breast and Ovarian Cancer Syndrome, then simply quitting smoking or exercising regularly is not enough. Thus to prevent Breast or Ovarian cancer, women sometimes opt for the following preemptive measures.
• Risk-reducing Mastectomy: This is a surgical procedure to remove both breasts even when there is no sign of cancer. A double mastectomy can significantly reduce the risk of developing cancer by 90-95%. However, before undertaking such an extreme measure, it is important to go through a thorough risk assessment and counseling beforehand.
• Oophorectomy: This is a surgical procedure used by Premenopausal women, and it involves the removal of both ovaries even when there is no sign of cancer. This procedure also reduces the amount of oestrogen produced by the body, and even lowers the risk of breast cancer. However, the sudden drop in oestrogen levels can have an effect similar to those produced by Menopause, i.e., hot flashes, troubled sleep, anxiety and depression, amongst others.
• Chemoprevention: This involves using drugs to prevent cancer. For example, Tamoxifen taken by high-risk women for a period of 5 years reduces the chance of developing breast cancer by half. Other alternatives to Tamoxifen are aromatase inhibitors and Raloxifene.
Diagnosis
The diagnosis for mutations of BRCA1 or BRCA2 is done through Screening tests in order to identify any abnormalities in the earlier stages.
For Women:
• Breast self-examination on a monthly basis, starting from the age of 18.
• The clinical examination of breasts twice a month, starting from the age of 25.
• MRI, short for Magnetic Resonance Imaging scans, on a yearly basis, starting from the age of 25.
For Men:
• Breast self-examination on a monthly basis, starting from the age of 30.
• The clinical examination of breasts on a yearly basis, starting from the age of 30.
• Mammogram at the age of 35 for those carrying the faulty BRCA2 gene. However, this is conditional upon the presence of gynecomastia, that is, the swelling of breast tissues in men.
• Screening for Prostate Cancer on a yearly basis starting from the age of 40, accompanied with a PSA blood test and rectal exam.
Treatment
The following is a list of treatment decisions to be made by people with Hereditary Breast or Hereditary Ovarian cancer.
• Risk-Reducing Surgeries: Women who carry the BRCA mutated genes are at a higher risk of a second or even third ovarian or breast cancer diagnosis. To prevent this recurrence, women who test positive for these hereditary mutations choose Bilateral Mastectomy or Oophorectomy rather than lumpectomy or radiation.
• Participation in Clinical Trials: There are research studies which are exploring Targeted Therapies to either treat or prevent Hereditary Cancers. In order to possibility participate in a clinical trial, women should ideally express their interests upon diagnosis itself, or before the treatment has begun.
• Ovarian Ablation: Ovaries produce most of the oestrogen in the body. As such, treatments may be taken to stop or lower the production of Oestrogen in the body. Young women with ER-positive breast cancer may opt for drugs which can stop their ovaries from producing oestrogen. Tamoxifen is one of the most commonly used drugs to treat ER-positive breast cancer.
• Aromatase Inhibitors: These are drugs given to post-menopausal women to reduce production of oestrogen by fat cells and adrenal glands.
• Chemotherapy: Research indicates that women with BRCA mutations have a better outcome if they use chemotherapy as opposed to those who do not. Individuals with BRCA mutations who are diagnosed with triple negative breast cancer respond particularly well to platinum-based chemotherapy.
Outlook
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The outlook for women varies by the Stage of cancer. The lower the stage, the higher the survival rate. These statistics are generally collected over a 5 year period survival rate. The following is the statistic for the different stages of cancer;
stage 0 or Stage 1: Almost 100%
Stage 2: 93%
Stage 3: 72%
Stage 4 (Metastatic): 22%
Stress and psychological issues
Going through treatment for Breast Cancer can be a stressful time, physically, emotionally, and socially. Those who attempt to deal with it by engaging in behaviours such as alcohol consumption, drugs or smoking, or by becoming sedentary have a poorer quality of life following the treatment. Which is why it is recommended to manage that stress by practicing relaxation and stress management techniques as coping strategies. However, while these would significantly lower anxiety, depression, etc, there is no evidence to suggest that they contribute to increasing cancer survival rates.
One can cope with the psychological stress and anxiety of Cancer in the following ways:
• Relaxation training and street management practices.
• Counselling.
• Cancer education.
• Social support.
• Medications to deal with the depression and anxiety.
• Regular exercise.