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Breast and Ovarian Cancer Risk Evaluation Program

You are probably familiar with at least some of the risk factors for breast and ovarian cancer, such as family history, age and reproductive history. You also may have heard about the discovery of certain genes that contribute to cancer. But how do these factors add up for you? Penn's Breast and Ovarian Cancer Risk Evaluation Program can help answer this question.

Cancer is a condition where certain cells in the body are no longer growing and dividing normally. Genes are the instruction manuals contained in all our cells. Cells receive many instructions about when to grow and divide, and when to stop growing. If certain genes are not working properly (mutation) then cells may not get the proper instructions about when to grow and divide.

In families with hereditary forms of cancer risk, a mutation is present in a single, very important gene, and is present at birth in all cells in the body. A child may inherit this gene mutation from a parent. Inheriting a mutation in a gene that plays a very important role in controlling normal cell growth substantially increases cancer risk. However, these cancer risk genes in no way guarantee that cancer will develop; inheriting a mutation in a cancer risk gene, means only that your risk is higher than someone who does not carry such a mutation in their cells.

BRCA1 and BRCA2 are the names for the first two genes to be discovered that increase risk for breast and ovarian cancer. Only about 5-10% of breast cancer and 5-10% of ovarian cancer is strongly related to mutations in these genes. While most women will develop breast or ovarian cancer because of non-inherited mutations in many different genes, a small number will inherit a significant risk of developing this cancer because of a single BRCA gene mutation.

In order to determine the chance that a mutation in a single, strong cancer risk gene is present, a complete family history, including at least three generations of relatives should be examined. The following features are associated with hereditary cancer:

• Multiple generations of people affected with the same or related cancers.
• At least some people with cancer diagnosed at early ages for that cancer.
• Some people in the family may have more than one type of cancer, like women with both breast and ovarian cancer.

Other Risk Factors

While many people believe that they are not at risk for breast or ovarian cancer if there is no family history, it is not true.

Other risk factors for developing breast cancer include:

• Age. Studies show that the risk of breast cancer increases as a woman gets older. Most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60. Also, breast cancer occurs more often in White women than African American or Asian women.
• A personal history of breast cancer. Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
• Certain breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) may increase a woman's risk for developing cancer.
• Estrogen. Evidence suggests that the longer a woman is exposed to estrogen (estrogen made by the body, taken as a drug, or delivered by a patch), the more likely she is to develop breast cancer. For example, the risk is somewhat increased among women who began menstruation at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy for long periods of time. Each of these factors increases the amount of time a woman's body is exposed to estrogen.
• DES. DES (diethylstilbestrol) is a synthetic form of estrogen that was used between the early 1940s and 1971. Women who took DES during pregnancy to prevent certain complications are at a slightly higher risk for breast cancer. This does not appear to be the case for their daughters who were exposed to DES before birth. However, more studies are needed as these daughters enter the age range when breast cancer is more common.
• Late childbearing. Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.
• Breast density. Breasts that have a high proportion of lobular and ductal tissue appear dense on mammograms. Breast cancers nearly always develop in lobular or ductal tissue (not fatty tissue). That's why cancer is more likely to occur in breasts that have a lot of lobular and ductal tissue (that is, dense tissue) than in breasts with a lot of fatty tissue.
• Radiation therapy. Women whose breasts were exposed to radiation during radiation therapy before age 30, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
• Alcohol. Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol.

Other risk factors for developing ovarian cancer include:

• Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60.
• Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
• Personal history. Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had breast or colon cancer.
• Fertility drugs. Drugs that cause a woman to ovulate may slightly increase a woman's chance of developing ovarian cancer. Researchers are studying this possible association.
• Talc. Some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer.
• Hormone replacement therapy (HRT). Some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.