Key links
Follow us on Social media
Contact us

Jnetics, PO Box 65520, London N3 9BU

Email: .(JavaScript must be enabled to view this email address)

Tel: 020 8123 5022

image


Frequently Asked Questions on Hereditary Cancers

Below are some common questions people ask about the BRCA-associated cancers and genetic testing. For more comprehensive information, click here to see our hereditary cancers resources. 

Please click on the (+) and (-) buttons to open and close the following information sections. If you have additional questions, please send them to .(JavaScript must be enabled to view this email address).

About BRCA

BRCA1 and BRCA2 are the names of two genes involved in the normal growth of cells in the body. Damage to these genes can cause an abnormal cell growth which can lead to cancer (See About BRCA for further information) 

Mutations in BRCA genes are most commonly associated with predisposition to hereditary breast, ovarian and prostate cancer (See Types of BRCA-associated cancer), although there is also evidence that BRCA mutations may also be involved in other types of cancer.

BRCA Risk

People with mutations in a BRCA gene are referred to as being BRCA positive, although the term BRCA carrier is also often used. Being BRCA positive does not mean that a person will definitely develop cancer, however they do have an increased risk relative to the general population (See About BRCA for further information).
Yes, men have the same chance of being BRCA positive as women. Although the risk of breast cancer for male carriers is lower than female carriers, breast cancer can still occur and men with BRCA mutations also have an increased risk of developing prostate cancer. Men can also pass BRCA mutations on to their children (both sons and daughters) in the same way as women can.
Since cancer affects 1 in 2 people in the UK at some point in their lives, most families will have at least one member who has had cancer. Since hereditary cancers are uncommon, having a family member with cancer does not mean that you are likely to be BRCA positive. However, the more relatives who have had breast, ovarian or prostate cancer, the younger their age at diagnosis, and the more closely related they are to you, the more likely it is that you could be at increased risk (see here for more information about how common BRCA mutations are).
You can be BRCA positive even if you have no family history of cancer, although this risk is lower than for those with a strong family history. It is thought that approximately 1 in 500 people in the UK general population and 1 in 40 people of Ashkenazi Jewish ancestry are BRCA positive (see here for information about how common BRCA mutations are).
It is estimated that around 1 in 40 people of Ashkenazi Jewish ancestry are BRCA positive relative to 1 in 500 in the general population. BRCA-associated cancers are therefore seen more frequently in Jewish people of Ashkenazi descent. If you are Ashkenazi and have a family history of breast, ovarian and/or prostate cancer, you may be at increased risk (See BRCA and Ashkenazi Jews ). Sephardi Jews have the same risk of being BRCA positive as the general population. However, if you are Sephardi and have a strong family history of breast, ovarian and/or prostate cancer, you could also be at increased risk.

BRCA Testing

Following referral from your GP to a regional genetics service, you will meet with a genetic counsellor to assess if you are eligible for BRCA testing on the NHS. If so, the genetic counsellor will discuss the implications of testing with you and allow you to decide whether or not you want to go forward. The test itself involves taking a small blood sample and analyzing it to look for certain mutations in the BRCA genes. Once the results are available, your genetic counsellor should be in contact to arrange a meeting to discuss the results (see here for more information about what BRCA testing involves).
A number of factors influence eligibility for BRCA testing on the NHS including whether or not you have had cancer yourself, your age, family history of breast, ovarian and prostate cancer and whether there is a known BRCA mutation in your family. Each regional genetics service sets its own criteria, so eligibility may vary between regions.  To identify whether or not you are eligible for BRCA testing, your GP needs to refer you to your local regional genetics service who will make an assessment based on their specific criteria (see Genetic testing for BRCA).
If you do not meet the criteria for BRCA testing on the NHS, you may be eligible for testing through the Breast and Ovarian Cancer Susceptibility Study (BOCS) if you have had breast or ovarian cancer yourself (click here for more information on this study). Alternatively, it is possible to pay for a test privately, whether or not you have been affected by cancer. Details of private service providers can be found in the resources section.
Not everyone who receives a cancer diagnosis will be automatically offered BRCA testing – it will be dependent on your cancer type, age and family history of cancer. If you have been diagnosed with breast, ovarian or prostate cancer and are Ashkenazi Jewish, you will usually meet the eligibility criteria, however it may be helpful to notify your oncologist of your Ashkenazi ancestry if they are unaware. If you do not meet the criteria for BRCA testing on the NHS, you may be eligible for testing through the Breast and Ovarian Cancer Susceptibility Study (BOCS) or can pay for a test privately (see the resources section for links to private services).

Implications of BRCA Testing

A positive BRCA test result means that you are at increased risk of cancer but does not mean that you will definitely get cancer. Women who carry a BRCA1 mutation have a 55-65% risk of developing breast cancer and a 39% risk of developing ovarian cancer by the age of 70. Women who carry a BRCA2 mutation have a 45% risk of developing breast cancer and an 11-17% risk of developing ovarian cancer by the age of 70. BRCA positive men are at increased risk of breast cancer and are more likely to develop prostate cancer than men who are not BRCA positive. For more information on cancer risk see the table in this section.
If you receive a positive test result, this means that your children also have a 50% chance of being BRCA positive. This is true for sons as well as daughters. If your children are adults, they may wish to consider the option of genetic testing. If they are children, this is something they may wish to consider at an appropriate point in the future. Your genetic counsellor will be able to provide you with support on when and how to discuss BRCA with your children.
If you are BRCA positive and are considering starting or expanding your family, you may wish to consider the option of Preimplantation Genetic Diagnostics (PGD). This is a procedure that aims to allow families to avoid passing on an inherited condition to their children through in vitro fertilisation (IVF). Ovarian Cancer Action provides useful information on starting a family for BRCA carriers.
If you receive a positive result, this could have implications for your family members who may also be carriers. Your genetic counsellor will be able to provide you with helpful advice on who to tell and how to tell them. Some clinics have prepared letters you can send out to relatives but you may prefer to tell people face to face. Or you may want to do a mix of both, depending on which relative it is and your relationship with them. 
If your test results are negative, your children will not inherit a BRCA mutation from you. It is, however, still possible that they could inherit a BRCA mutation from their other parent.
If you are BRCA positive, you can help to reduce your risk of developing cancer through risk reducing treatment and lifestyle changes. When considering your options, it is worth thinking about what treatment options are available, how much they will reduce your risk of developing cancer and any immediate and long term side effects and impacts on fertility and family planning. Your genetic counsellor will be able to advise you on an appropriate course of action that works for you and your family at this time in your life, taking into account life choices such as when to have children and the choices you make about work and your career (see here for more information about managing your risk of developing cancer).