Women at higher risk for breast cancer – and up to 1 in 10 women are – should also see a gynecologic oncologist for a simultaneous breast/ovarian cancer exam
October is Breast Cancer Awareness Month, which is one of the most successful health issue “months” because it spurs millions of women to have their breasts examined for cancer. Probably the most motivated women are those who have a genetic predisposition to breast cancer, which is anywhere from 5-10 percent of women.
I wish those motivated women would come to me, or another gynecologic oncologist, so we could check for ovarian cancer at the same time – because such women are at heightened risk of developing ovarian cancer as well. But many don’t know that, and breast exams by a primary care physician or family physician will not evaluate for ovarian cancer at the same time.
Why is that so important? Though ovarian cancer occurs considerably less often than breast cancer, it is considerably more deadly — and harder to detect.
There’s no test for ovarian cancer so women need to be aware of their family health history to determine if they may have a genetic predisposition for it. There is a blood test to detect if women have that genetic predisposition. Having family members such as a mother, sister, aunt or grandmother with either breast or ovarian cancer raises the chances of a women getting either types of cancer herself.
So while many women are very much aware and concerned about their risk to get breast cancer, Breast Cancer Awareness Month is also an excellent time to figure out if they should be concerned and checked for ovarian cancer too.
The link between breast cancer and ovarian cancer risk
What we’re talking about primarily are the BRCA1 and BRCA2 genes that predispose women who have inherited a mutation in those genes to breast cancer and ovarian cancer. BRCA1 & 2 are involved in DNA repair and cell growth, but when mutations in those genes occur, they don’t repair DNA so well, and cancer can result — breast and/or ovarian cancers.
Not only do these mutations put the woman at risk, her offspring have a 50 percent chance of inheriting the same mutation. And they have the same predisposition to breast or ovarian cancers as their mother with BRCA1 or 2 mutations, as well as for fallopian tube cancer and peritoneal cancer. Men can also have and pass along to their offspring BRCA1 & 2 mutations, which puts the man at higher risk of breast, prostate and pancreatic cancers.
Here are the important genetic numbers for women regarding breast and ovarian cancers.
- About 12 percent of women will get breast cancer; about 55-65 percent of women with the BRCA1 mutation will get breast cancer (45 percent with BRCA2 mutations).
- About 1.3 percent of women will get ovarian cancer; about 39-46 percent of women with BRCA1 mutation will get ovarian cancer (12-20 percent with BRCA2 mutations).
- Of the 2.6 million U.S. women diagnosed with breast cancer, 5-10 percent got it because of an inherited genetic defect, and each one should immediately see a gynecologic oncologist to be checked for ovarian cancer.
Checking for two cancers at once
Generally, when patients see their primary care physician or OB-GYN knowing that they have a genetic risk for cancer, their breasts get the attention. This is partly due to breast cancer being relatively easy to look for and diagnose.
Monitoring for ovarian cancer tends to get missed — particularly if the woman doesn’t know she should be watching for it, which is often the case. Also, ovarian cancer is more difficult to diagnose. In addition, ovarian cancer symptoms are often minimal and unnoticeable until the later stages, so most cases go undiagnosed until then when treatment isn’t as effective.
When you see a gynecologic oncologist for your breast exam, we’ll also evaluate you for ovarian cancer. First thing I’ll do is find out about you and your family’s medical history. Next comes a pelvic exam, in which I’ll look for signs, such as an enlarged ovary or fluid in the abdomen.
If I suspect cancer, we’ll do tests that may include blood work and various forms of imaging (MRI, X-ray, ultrasound and others). A definitive diagnosis of ovarian cancer is only available after a pathologic sample is given, most commonly from a surgery.
And if we (meaning a gynecologic oncologist) find breast cancer and ovarian cancer, we can perform surgeries on both at the same time. This sounds bad, but in reality doing both operations at the same time reduces stress, cost and worry for the woman. And increasing a cancer patient’s quality of life is always our goal.
Not sure if you are at genetic risk of breast and/or ovarian cancer? Here are some guidelines:
- You have had multiple cancers
- A close relative has had ovarian cancer or a breast cancer diagnosed before menopause
- You are an Ashkenazi Jew (Eastern Europeans predisposed to BRCA mutations)
- If diagnosed with breast cancer before age 50 and have had a relative with ovarian cancer or a male relative with breast cancer, you are heightened risk for ovarian cancer
- You have a close male relative with breast cancer
- More than two close relatives on the same side of your family had ovarian cancer, or had breast cancer before age 50.
- A relative in your family has a known BRCA mutation
If you answered yes to any of those, you should have your breast and ovaries examined for cancer by a gynecologic oncologist. We’ll also put you in touch with a genetic counselor who is similar to a family “medical history detective.” The counselor’s evaluation can determine if you need genetic testing via blood or saliva sample to confirm a suspicion of breast or ovarian cancer genetic predisposition.
It’s Breast Cancer Awareness Month, which is a great time to see if you need the 2 for 1 exam. We’re here to help in any way we can.