BRCA2, familial breast-ovarian cancer susceptibility 2
Is it safe for people with BRCA2 gene mutations to use hormone replacement therapy after an oophorectomy?
There is much debate over this question. Use of hormone replacement therapy (HRT) can increase the risk for breast cancer. Many physicians are nervous to prescribe HRT to a woman whose risk for breast cancer is already high. The benefits of HRT after prophylactic oophorectomy can greatly improve quality of life for some women though. Some research has shown that prophylactic oophorectomy reduces the risk for breast cancer even with HRT use. More specifically, one study demonstrated that short-term use of HRT following an oophorectomy did not significantly alter breast cancer risk. There are many factors to discuss with your healthcare provider before deciding whether you should use HRT.
- Rebbeck, T.R., Friebel, T., Wagner, T., et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2005; 23: 31: 7804-7810
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Will taking birth control increase the risk for breast cancer in people with BRCA2 gene mutations?
The use of oral contraceptive pills (birth control pills) leads to a decreased risk of developing ovarian cancer. More specifically, studies have shown that the use of birth control pills reduced the risk of ovarian cancer by up to 60% in BRCA2 mutation carriers. That being said, some studies suggest that using birth control may increase the risk for breast cancer. Other research shows that birth control pills prescribed today do not increase early-onset breast cancer risk for women with BRCA2 gene mutations since pills now contain a lower dose of estrogen. There are many different types of oral contraceptive pills, and the risks differ based on the specific formula. The benefits of oral contraceptive use may outweigh the potential negative consequences for some women. It is important to talk with your physician about what is right for your health.
- McLaughlin JR, Risch HA, Lubinski J, et al. Reproductive risk factors for ovarian cancer in carriers of BRCA1 or BRCA2 mutations: A case-control study. Lancet Oncology 2007; 8(1):26-34.
Is prenatal testing available for Hereditary Breast and Ovarian Cancer syndrome caused by BRCA2 gene mutations?
Preimplantation genetic diagnosis (PGD) is available for Hereditary Breast and Ovarian Cancer syndrome if one of the parents is known to carry a BRCA2 mutation. PGD is performed on embryos produced through IVF. PGD allows for parents to only implant embryos into the mother's uterus that do not have the BRCA2 gene mutation. PGD is still a very costly procedure though, and it is not guaranteed to lead to pregnancy every time.
Some labs may accept prenatal specimens for genetic testing if a parent is known to carry a BRCA2 mutation. With prenatal testing, the baby's DNA is tested during the pregnancy to determine whether the baby has the BRCA2 gene mutation. The procedures available to obtain the baby's DNA during a pregnancy are associated with a risk of pregnancy loss. Prenatal testing is not commonly utilized or recommended for adult onset conditions like Hereditary Breast and Ovarian Cancer syndrome.