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What Every Woman Needs to Know about Breast and Ovarian Cancers

A little knowledge can go a long way in helping you understand your risk for breast and ovarian cancers. Once you learn your risk for these cancers, we hope you will talk to you doctor and develop a strategy to reduce your risk or detect these diseases at early, non-life-threatening stages.

Breast and Ovarian Cancer Basics

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the breast, it is called breast cancer. About 7 out of 100 women (or 7%) will be diagnosed with breast cancer by the time they turn 70 years old.

Ovarian cancer is far less common. About 1 out of 100 women (or 1%) will be diagnosed with ovarian cancer by age 70. Though it is less common than breast cancer, ovarian cancer causes more deaths than any other cancer of the female reproductive system.

About 5–10% of breast and 10-15% of ovarian cancers are hereditary. These hereditary breast and ovarian cancers are caused by inherited changes in genes such as BRCA1 and BRCA2.

Breast and Ovarian Cancer Basics for Young Women

While breast and ovarian cancers are most common in older women (about 89% of breast cancers occur in women older than 45 years of age), they can and do occur in younger women. There are some important differences when these cancers do affect young women:

  • Breast and ovarian cancers in young women are more likely to be hereditary (passed down through families and because of an inherited BRCA gene mutation).
  • Breast and ovarian cancers in young women are more likely to be diagnosed at a later stage and are often more aggressive and difficult to treat.
  • Young women can face unique issues when diagnosed, including concerns about body image, fertility, finances, and feelings of isolation.

Steps You Can Take Now

Learn More About Breast and Ovarian Cancers

Every woman can benefit from learning the risk factors and symptoms of breast and ovarian cancers.

Risk Factors for Breast Cancer at Any Age

If you have one or more of these factors, it does not mean you will get breast cancer. Talk to your doctor about ways to reduce your risk.

Reproductive Risk Factors

  • Being younger (before age 12) when you first had your menstrual period
  • Starting menopause at a later age (after age 55)
  • Being older (after age 35) at the birth of your first child
  • Never giving birth
  • Never breastfeeding for a long duration (1 year plus)
  • Long-term use of hormone replacement therapy

Other Risk Factors

  • Getting older
  • Personal history of breast cancer or some noncancerous breast diseases
  • Family history of breast cancer
  • Ashkenazi Jewish ancestry (ancestors from Central or Eastern Europe)
  • Treatment with radiation therapy to the breast or chest
  • Dense breast tissue – a condition that can be diagnosed by a mammogram
  • Being overweight (increases risk for breast cancer after menopause)
  • Having a mutation in the breast cancer-related genes BRCA1 or BRCA2
  • Drinking alcohol (more than one drink a day)
  • Not getting regular exercise

Symptoms of Breast Cancer

Pay attention to your body and know what is normal for you. If you have any signs that worry you, be sure to see your doctor right away.

  • New lump in the breast or underarm (armpit)
  • Thickening or swelling of part of the breast
  • Irritation or dimpling of breast skin
  • Redness or flaky skin in the nipple area or the breast
  • Pulling in of the nipple or pain in the nipple area
  • Nipple discharge other than breast milk, including blood
  • Any change in the size or the shape of the breast
  • Pain in any area of the breast

Risk Factors for Ovarian Cancer

If you have one or more of these factors, it does not mean you will get ovarian cancer. Talk to your doctor about ways to reduce your risk.

If you have:

  • Reached or are past middle age
  • Never given birth or had trouble getting pregnant
  • A family history of ovarian cancer (mother, sister, aunt, or grandmother)
  • Ashkenazi Jewish ancestry (ancestors from central or Eastern Europe)
  • A mutation in the breast cancer-related BRCA1 and/or BRCA2 genes
  • Been diagnosed with breast, uterine, colorectal (colon), or cervical cancer or melanoma
  • Been diagnosed with endometriosis (a condition where tissue from the lining of the uterus grows elsewhere in the body)

Symptoms of Ovarian Cancer

Pay attention to your body and know what is normal for you. See a doctor if you have any of these signs for two weeks or longer and they are not normal for you.

  • Vaginal bleeding or discharge from your vagina that is not normal for you
  • Pain in the pelvic or abdominal area (the area below your stomach and between your hip bones)
  • Back pain
  • Bloating, which is when the area below your stomach swells or feels full
  • Feeling full quickly while eating
  • A change in your bathroom habits, such as constipation, diarrhea, or having to pass urine very urgently or very often

Talk to your Doctor

The next time you visit the doctor, consider talking about what you have learned about breast and ovarian cancers.

Be sure to tell your doctor about your family history of cancer (especially breast, ovarian, fallopian tube, pancreatic, and prostate cancers) and about any other risk factors you may have.

If you need help collecting and organizing your family health history, use the U.S. Surgeon General's family health history portrait, https://familyhistory.hhs.gov/.

Together, you and your doctor can develop a personalized strategy to reduce your risk.

 

Genetic Counseling and Testing

Are genetic tests available to detect BRCA mutations?

Yes. Several testing methods are available to detect BRCA1 and BRCA2 mutations. Genetic counseling is recommended before and after a genetic test.

How is genetic testing done?

A blood or saliva sample is needed for a genetic test. The blood is drawn in a laboratory, doctor's office, hospital, or clinic and then sent to a laboratory that does the tests. It usually takes several weeks or longer to get the test results.

Genetic counseling is recommended before and after a genetic test. A genetic counselor will usually conduct risk assessments based on your personal and family medical history. He or she will then talk to you about things like:

  • whether a genetic test is right for you
  • the specific tests that might be used
  • the accuracy of the tests
  • what happens if you have a positive or a negative test result
  • the possibility that a test result might not be informative
  • the emotional risks and benefits of genetic test results
  • how genetic testing results may impact other members of your family

Should I get genetic counseling and testing?

The United States Preventive Services Task Force recommends that women with specific patterns of breast, ovarian, tubal, or peritoneal cancer in their family history should consider genetic counseling (http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfact.pdf).

Before you consider genetic counseling and testing, we recommend you take the Know:BRCA Assessment and talk to your doctor to learn if your family history puts you at an increased risk for a BRCA gene mutation.

In a family with a history of breast and/or ovarian cancer, it may be most helpful to first test a family member who has breast or ovarian cancer. If that person is found to have a BRCA mutation, then other family members can be tested to see if they also have the mutation.

What are some of the benefits of genetic testing for breast and ovarian cancer risk?

There can be benefits to genetic testing, whether a person receives a positive or a negative result. Some potential benefits of a negative test result (meaning you do not have a BRCA1 or BRCA2 gene mutation) include a sense of relief and the possibility that special screening, tests, or surgeries may not be needed. However, even if you test negative for a BRCA1/2 mutation, you can still develop breast or ovarian cancer. You should talk to your doctor about screening that is right for you.

A positive test result (meaning you do have a BRCA1 or BRCA2 gene mutation) helps you to better understand your personal risk of developing breast and ovarian cancers. You can then make choices on what to do to reduce your risk and about what screening is right for you.

What are some of the risks of genetic testing for breast and ovarian cancer risk?

The medical risks from having blood drawn for a genetic test are very small. Test results may have an effect on your emotions, social relationships, finances, and medical choices. If you receive a positive test result (meaning you do have a BRCA gene mutation), you may feel anxious, depressed, or angry. You will have to make choices about whether or not to take steps to lessen your risk of developing breast or ovarian cancer and about what screening is right for you. You may choose to undergo preventive measures, such as prophylactic surgery.

If you receive a true negative test result (meaning you do not have a BRCA gene mutation) you may experience survivor guilt, caused by the knowledge that you likely do not have an increased risk of developing a disease that may have affected your loved ones.

Because genetic testing can reveal information about more than one family member, the emotions caused by test results can create tension within families. Test results can also affect personal choices, such as marriage and childbearing.

If I have a higher chance than most women of having a BRCA gene mutation – but I decide not to get genetic testing – what else should I do?

Women at increased risk of having a BRCA gene mutation but who decide not to have genetic counseling and testing should talk to their doctor. These women may want to consider monitoring and screening that are similar to that for women who carry the gene mutation.

For young women, this might include starting to get mammograms earlier than other women.

How much does genetic testing cost?

The cost for BRCA1 and BRCA2 mutation testing depends on the type of test you need, but usually ranges from several hundred to several thousand dollars. The type of testing needed can depend on many factors such as whether someone in your family has a previously identified mutation, or whether your ancestry suggest a certain type of mutation.

Will my insurance pay for genetic testing?

Many insurance companies will cover the cost of genetic testing for people who have had cancer or who have a family history of cancer and who meet certain guidelines. Check with you insurance company to find out if genetic testing is covered in your policy.

The Affordable Care Act stipulates coverage for genetic counseling and BRCA testing for women whose doctor determines they are appropriate according to the USPSTF guidelines (http://www.dol.gov/ebsa/faqs/faq-aca12.html).

For more information about insurance, Medicare, and Medicaid coverage, and options if your insurance company does not cover genetic testing, visit: http://www.facingourrisk.org/info_research/finding-health-care/financial-help/index.php.

What if I do not have insurance? What if my insurance does not cover genetic testing?

There are options if you want genetic testing but do not have insurance, or if insurance will not cover the testing costs. A genetic counselor can help you see if you qualify for financial assistance. There are also nonprofit and government organizations that provide funding for people who qualify and cannot afford testing. Lastly, some research studies will cover costs of genetic testing if you are willing to be part of the study. For more information about options for finding assistance in paying for BRCA1 and BRCA2 testing:

Insurance, Financial Assistance, Cost of Services - Facing Our Risk of Cancer Empowered (F.O.R.C.E.)

Genetic Testing Assisstance - Bright Pink

If I find out I have a gene mutation, will it affect my ability to get health or other types of insurance?

Federal and state laws prohibit health insurance companies from denying coverage to individuals based on results from genetic testing, but the same protections do not apply to life, disability, or long-term care insurance.

The Genetic Information Nondiscrimination Act of 2008 (GINA) is a federal law that prohibits health insurance companies from using genetic information to make decisions about your insurance coverage, rates, or preexisting conditions. The law also prohibits most employers from using genetic information for hiring, firing, or employment decisions, including promotion. For more information on GINA: http://www.genome.gov/Pages/PolicyEthics/GeneticDiscrimination/GINAInfoDoc.pdf

GINA protections do not apply to life insurance, disability insurance, and long-term care insurance. When applying for these types of insurance, people may be asked to sign forms that give an insurance company permission to access their medical records. The insurance company may take genetic test results into account when making decisions about coverage.

Some physicians keep genetic test results out of medical records. However, even if such results are not included in a person's medical records, information about a person's genetic profile can sometimes be gathered from that person's family medical history.

For more information on legal issues surrounding this topic, see Bright Pink's Legal Resources for Women at High Risk and FORCE's Insurance Privacy Issues.

Where can people get more information about genetic testing for cancer risk?

A person who is considering genetic testing should speak with a doctor, counselor, or other health care worker trained in genetics before deciding whether to be tested.

Alternatively, contact NCI's Cancer Information Service (CIS) by phone at 1-800-4-CANCER or the LiveHelp link on NCI's Cancer.gov Web site. The CIS can provide more information about genetic testing and help in finding a health care professional trained in genetics.

The following not-for-profit organizations offer ways for you to speak with a genetics counselor for free:
https://www.brightpink.org/high-risk-support/genetic-counseling/
https://www.facingourrisk.org/support/helpline.php
http://www.sharsheret.org/how-we-help/women-all-ages/at-risk-brca-positive