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Maybe it’s your mother. Your sister. An aunt who had a double mastectomy at 34 because breast cancer kept finding the women in her family before it found her. When cancer runs in a pattern like that, a simple blood or saliva test can tell you whether it’s a BRCA1 or BRCA2 mutation, and more importantly, exactly what you can do about it before cancer ever develops.
Quick answer: BRCA1 and BRCA2 are genes that normally repair damaged DNA. A harmful mutation in either one raises a woman’s lifetime breast cancer risk from about 13% to more than 60%, and her ovarian cancer risk from about 1% to as high as 58%. A blood or saliva test can identify the mutation. From there, carriers can choose enhanced screening, risk-reducing medication, or preventive surgery, which lowers breast cancer risk by at least 95%.
What BRCA1 and BRCA2 Actually Do
BRCA1 and BRCA2 aren’t cancer genes in the sense most people assume. Everyone has two working copies of each gene, and their normal job is to repair damaged DNA before a cell can turn cancerous. The problem starts when someone inherits a harmful change, or pathogenic variant, in one copy. That leaves them with only one functional backup instead of two, and when that remaining copy is damaged later in life, the cell loses its repair ability and can become cancer.
About 5% to 10% of all breast cancers are linked to an inherited gene mutation, and BRCA1 and BRCA2 are the most commonly identified cause. The mutation can come from either parent, and both men and women can carry and pass it on.
How Much Does a BRCA Mutation Actually Raise Your Risk?
More than 60% of women who inherit a harmful change in BRCA1 or BRCA2 will develop breast cancer during their lifetime, compared with about 13% of women in the general population. Some large cohort studies put the number even higher by age 80, closer to 72% for BRCA1 carriers and 69% for BRCA2 carriers.
Ovarian cancer risk climbs from about 1.1% in the general population to 39%-58% for BRCA1 carriers and 13%-29% for BRCA2 carriers. BRCA1 carries the steeper ovarian cancer risk of the two genes.
Among women previously diagnosed with breast cancer, 30%-40% of BRCA1 carriers and 25% of BRCA2 carriers will develop cancer in the opposite breast within 20 years, compared with about 8% of women without the mutation.
A positive result isn’t limited to breast and ovarian cancer either. Up to 5% of BRCA1 carriers and 5%-10% of BRCA2 carriers will develop pancreatic cancer during their lifetime, compared with about 1.7% of people in the general population. Men face elevated risk too: about 7%-26% of men with a BRCA1 mutation and 19%-61% of those with a BRCA2 mutation will develop prostate cancer by age 80, compared with about 10.6% of men overall. Men can also develop breast cancer themselves, about 0.2%-1.2% of male BRCA1 carriers and 1.8%-7.1% of male BRCA2 carriers by age 70, compared with about 0.1% of men in the general population.
None of this means a positive result is a diagnosis. It’s a risk profile, not a sentence, and some carriers never develop cancer at all.
Who Should Actually Get Tested
Genetic testing isn’t recommended for everyone. It’s most useful, and most likely to be covered by insurance, for people with:
A known BRCA mutation already identified in a close relative
Ashkenazi Jewish heritage (the mutation carrier rate is about 1 in 50 in this population, versus roughly 1 in 400 in the general population)
A personal or family history of breast cancer diagnosed at age 50 or younger
A personal or family history of ovarian cancer, male breast cancer, pancreatic cancer, or metastatic or high-risk prostate cancer
If any of that sounds like your family, the right first call is a genetic counselor, not a lab. A counselor reviews your actual family history before you test, explains what a positive, negative, or uncertain result would mean for you specifically, and helps you avoid a common trap: a negative result doesn’t erase risk if your family’s mutation was never identified in the first place, and an uncertain (VUS) result shouldn’t drive major decisions on its own.
Your Options After a Positive Result
There’s no single right path here. Age, family history, whether you’ve finished childbearing, and personal risk tolerance all factor in. Most women choose a combination of these strategies rather than just one.
At a glance:
Enhanced surveillance (annual MRI plus mammogram, alternated every 6 months): doesn’t prevent cancer, but catches it earlier
Risk-reducing mastectomy: at least 95% reduction in breast cancer risk, but irreversible
Risk-reducing salpingo-oophorectomy: lowers ovarian cancer risk by about 80%, but triggers surgical menopause
Chemoprevention (tamoxifen, raloxifene): lowers contralateral and estrogen-positive breast cancer risk in some BRCA carriers, though not FDA-approved specifically for BRCA
Oral contraceptives: 30%-50% lower ovarian cancer risk, with a small increase in breast cancer risk during use
Enhanced Surveillance
NCCN and American Cancer Society guidelines recommend annual breast MRI starting at age 25 for BRCA carriers, with annual mammography added at age 30. Most centers alternate the two tests every six months, so the breasts are imaged twice a year total.
Ovarian cancer is a different story. No screening method has been shown to catch ovarian cancer early enough to actually improve survival, including transvaginal ultrasound and CA-125 blood testing. That’s the main reason surveillance alone isn’t considered adequate protection against ovarian cancer the way it is for breast cancer, and why surgery plays a bigger role on that side.
Risk-Reducing Mastectomy
This is the most effective single intervention available. Bilateral mastectomy reduces breast cancer risk by at least 95% in women with a harmful BRCA1 or BRCA2 variant. It isn’t 100%, because no surgery removes every cell of at-risk tissue, but nothing else comes close to that number.
There are two surgical approaches. A total mastectomy removes the nipple and areola along with the breast tissue and offers slightly stronger risk reduction. A nipple-sparing mastectomy preserves the nipple and areola and typically allows for a more natural-looking reconstruction. The surgery is irreversible, and while most women who choose it are satisfied with their decision, it’s normal to experience anxiety around body image and the loss of nipple sensation, which can affect sexual arousal. This is exactly why the decision belongs in a conversation with a breast surgeon and reconstructive surgeon together, not a decision made from a spreadsheet of statistics.
Risk-Reducing Salpingo-Oophorectomy
For ovarian cancer, removing the ovaries and fallopian tubes is the most effective option available. It lowers ovarian cancer risk by about 80% and reduces all-cause mortality by roughly 68%, according to a Cochrane review. NCCN guidelines typically recommend the surgery between ages 35 and 40 for BRCA1 carriers and between 40 and 45 for BRCA2 carriers, since ovarian cancer tends to develop later in BRCA2 carriers, or once childbearing is complete. Some research suggests this surgery also modestly lowers breast cancer risk, though other studies haven’t found that effect, so it shouldn’t be counted on as a breast cancer prevention strategy on its own.
The trade-off is real: removing the ovaries triggers immediate surgical menopause, with hot flashes, sleep disruption, and mood changes that can be more abrupt than natural menopause. Short-term hormone therapy after surgery can ease these symptoms for many women, which is worth discussing with your surgical team before the procedure, not after.
Chemoprevention
Tamoxifen and raloxifene are FDA-approved to lower breast cancer risk in women at elevated risk generally, but it isn’t yet clear whether they work the same way for women whose risk comes specifically from an inherited BRCA mutation. What the evidence does show: tamoxifen appears to lower the risk of a second, contralateral breast cancer in BRCA1 and BRCA2 carriers who’ve already had one breast cancer diagnosis, and it reduces estrogen-receptor-positive breast cancer risk specifically in BRCA2 carriers.
Oral contraceptives are worth a separate conversation. Women who’ve ever used them, including BRCA carriers, have about a 50% lower risk of ovarian cancer than women who never have. The trade-off is a modest increase in breast cancer risk while using them, so this is a genuinely personal calculation to make with a provider, not a default recommendation.
Lifestyle Factors
Maintaining a healthy weight, staying physically active, limiting alcohol, and eating a diet built around vegetables and whole grains all support overall cancer risk reduction. Worth saying plainly: none of this comes close to offsetting the risk increase from a BRCA mutation on its own. Lifestyle changes are a complement to medical risk management, not a substitute for it.
Why Knowing Your Status Still Matters, Even Without Cancer
Genetic testing isn’t only useful before a diagnosis. If a BRCA-related cancer does develop, that same mutation actually becomes useful in treatment. Cancer cells that carry a BRCA mutation struggle to repair the kind of DNA damage caused by certain chemotherapy drugs and by a newer class of drugs called PARP inhibitors, which include olaparib and talazoparib. Knowing your BRCA status ahead of time gives your care team more options if you ever need them.
Frequently Asked Questions
Does a BRCA mutation mean I’ll definitely get breast cancer?
No. It raises lifetime risk substantially, to more than 60% versus about 13% for the general population, but it’s a risk factor, not a diagnosis. Some carriers never develop cancer.
How much does a preventive mastectomy actually lower risk?
At least 95%, according to NCI-reviewed research. No surgery removes 100% of at-risk breast tissue, so a small residual risk remains.
At what age should BRCA carriers start breast cancer screening?
Annual MRI starting at age 25, with mammography added at age 30, alternated every six months, unless someone has already had a risk-reducing mastectomy.
Is BRCA genetic testing covered by insurance?
Often, yes, when a person meets recognized risk criteria such as family history or Ashkenazi Jewish heritage. Coverage details vary by plan, and a genetic counselor can usually confirm what’s covered before you test.
Can men carry a BRCA mutation?
Yes. Men can inherit and pass on BRCA mutations. BRCA2 carriers in particular face elevated breast cancer risk compared with the general male population, and both genes raise prostate cancer risk.
What’s the difference between a mastectomy and a salpingo-oophorectomy for BRCA carriers?
A risk-reducing mastectomy removes breast tissue to lower breast cancer risk. A risk-reducing salpingo-oophorectomy removes the ovaries and fallopian tubes, typically between ages 35-40 for BRCA1 carriers and 40-45 for BRCA2 carriers, to lower ovarian cancer risk.
Talk to a Genetic Counselor and Surgical Team Before You Decide
None of these options are one-size-fits-all, and the right combination depends on your specific mutation, family history, age, and priorities. If you’ve had a positive BRCA result, or a family history that makes you wonder whether you should test, the next step is a conversation with a genetic counselor and a surgeon who can walk through your actual numbers, not general ones.
Mission Surgical Clinic works with patients across the Inland Empire on exactly these decisions, including patients covered under the Inland Empire Health Plan (IEHP). Call 888-754-0626 or email admin@missionsurgical.com to talk through your options.
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