BRCA Genes: What’s your Breast cancer risk?

By: Dr. Christine Horner

On May 14, 2013, the world woke to the shocking news that Angelina Jolie, a young actress and humanitarian graced with exceptional beauty and fame, and a mother of six, had undergone a double mastectomy and breast reconstruction. A blood test revealed that she had the BRCA1 gene mutation. Her doctors told her that her risk of developing breast cancer was 87 percent. Angelina said that the reason she decided to let the public know about her health situation was to raise awareness about this genetic condition and to help other women not to be afraid to take action. Surgery may have been the best course of action for Ms. Jolie, but it may not be for many other women with the BRCA gene mutations.
 
What BRCA Genes Do
The BRCA1 and BRCA2 genes are classified as tumor-suppression genes.

The acronyms come from the full names of the genes: breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2. They give instructions for proteins to suppress tumor growth and to help repair damaged DNA. Your DNA is a frequent target for assaults from a variety sources, especially from oxygen free radicals and toxins. Because injuries are common, your body keeps a repair crew on call to fix the damage.

But, if the crew lacks the right tools to repair the DNA—as it does with BRCA gene mutations—misinformation can be passed on that may lead to cancer. Specific types of mutations of the BRCA1 and BRCA2 genes are associated with a significantly higher risk of breast and ovarian cancer. These abnormal genes also increase the risk of other cancers including cancers of the cervix, uterus, pancreas, colon, stomach, gallbladder, and skin (melanoma). Men can also have a BRCA1 mutation and they are at a higher risk for developing prostate cancer at a younger age.

Most women do not carry the BRCA mutations. In fact, over 99 percent of us do not. Only about 5 to 7 percent of women diagnosed with breast cancer have this defect. This means that for the vast majority of women, the major risk factors for developing breast cancer are not genetic, but rather come from influences under our control, such as diet and lifestyle. These same diet and lifestyle factors also impact the risk of breast cancer in women with malfunctions in their BRCA genes.
 
Should You Be Tested for BRCA1 and 2?
Because problems in the BRCA genes are uncommon, testing is not routinely recommended. Women with a strong family history of breast and ovarian cancer, especially diagnosed at younger ages, may want to seek genetic counseling. There are many controversial issues regarding genetic testing that you should fully explore with your doctor before you consent to the test. If you do decide to be tested for the BRCA genes, make sure you educate yourself as much as possible about all of your options.
 
How to Dodge the BRCA Bullet
The most important point for you to know is this: Not everyone who has a BRCA gene mutation develops breast cancer. Estimates currently are about 80 percent of women with this defect will develop breast cancer if they live to be eighty years of age—20 percent will not. When the family lineages for those who carry the BRCA gene mutations have been traced back in time, the risk of breast cancer was three times lower 100 years ago.
With this news, two important questions may have popped up for you:
Why do some women with the gene mutations avoid cancer? And why was the risk much lower in the past? No doubt the answers are linked to diet and lifestyle choices—just as they are for women who do not have this genetic defect.
There are few published studies that focus on the influence that diet and lifestyle have on the risk of breast cancer in women with BRCA mutations.

However, the studies that are available that show that consuming certain foods and dietary supplements reduces the risk—substantially. 

The foods and supplements include:
 
Caffeinated coffee: Drinking several cups of joe a day can drop the risk for those with the BRCA1 gene mutation by as much as 70 percent!
 
Selenium: This essential mineral has several anticancer properties, including helping to repair oxidative DNA damage. A 2006 double-blind placebo-controlled study of 200 women with the BRCA1 mutation investigated the effects of selenium supplementation and the risk of breast cancer. The women were given either selenium supplements or a placebo. After two years, those taking selenium supplements had an incidence of breast cancer that was two times lower than those taking the placebo.
 
Omega-3 fatty acids: This type of fat—found in generous amounts in wild caught salmon, flaxseeds, and walnuts—has many health promoting properties, including positively influencing the BRCA1 gene. According to a 2007 French study, omega-3 fatty acids may reduce the incidence of BRCA-related tumors by 30 percent.
 
Vitamin D: A study published in the Journal of Cell Biology found that vitamin D plays a significant role in turning off a pathway that can cause an activation of the mutated BRCA1 gene.
 
Ginkgo biloba: Chinese researchers in 2011 discovered that this herb may prevent BRCA1-associated ovarian cancer risk.
 
BRCAs on-the-Blink Means Choices 
If you carry the BRCA gene mutations, there are many options to lower your risk. Numerous considerations go into determining what course of action may be best for each individual. Surgery may be the superior approach in certain situations. However for most women, effective safe alternatives to surgery that include a healthy diet and lifestyle, along with key nutritional supplements may be a wiser. As a former surgeon, I recommend you consider them first. Your circumstances are unique, so make sure you educate yourself as much as possible to determine which path is right for you.
 
Sources:
Evans, D., A. Shelton, E. Woodward, et al. “Penetrance estimates for BRCA1 and BRCA2 based on genetic testing in the Clinical Cancer Genetics service setting: risks of breast/ovarian cancer quoted should reflect the cancer burden in the family.” BMC CancerVol. 8. (May 2008): 155.
 
Gigert, R., V. Hanf, G. Emons, et al. “Membrane-bound melatonin receptor MT1 down-regulates estrogen responsive genes in breast cancer cells.” Journal of Pineal Research Vol. 47. (Aug 2009): 23-31.
 
Hill, S., T. Frasch, S. Xiang, et al. “Molecular mechanisms of melatonin anticancer effects.” Integrative Cancer Therapies Vol. 8. (Dec 2009): 337-346.
 
Jiang, W., W. Qiu, Y. Wang, et al. “Ginkgo may prevent genetic-associated ovarian cancer risk: multiple biomarkers and anticancer pathways induced by ginkgolide B in BRCA1-mutant ovarian epithelial cells.” European Journal of Cancer Prevention Vol. 20. (Nov 2011): 508-517.
 
Jourdan, M. K. Maheo, A. Barascu, et al. “Increased BRCA1 protein in mammary tumours of rats fed marine omega-3 fatty acids.” Oncology Reports Vol. 17. (Apr 2007): 713-719.
 
Liort, G. M. Peris, I. Blanco. “[Hereditary breast and ovarian cancer: primary and secondary prevention for BRCA1 and BRCA2 mutation carriers].” Medicina Clínica Vol. 128. (Mar 2007): 468-476.
 
Pijpe, A. N. Andrieu, D. Easton, et al. “Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK). British Medical Journal Vol. 345. (2112): e5660.
 
Tomasz, H., B. Tomasz, J. Gronwald, et al. “A lowering of breast and ovarian cancer risk in women with the BRCA 1 mutation by selenium supplementation of diet.” Hereditary Cancer in Clinical Practice Vol. 4. (Jan 2006): 58.

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