- Question from AWT: Hello. I am turning 39 in 1 week and I'm BRCA1-positive. My aunt and mother both contracted cancer at ages 37 and 38. Both had double mastectomies and are survivors. I have always wanted children yet do not have a partner. I have not been on the pill in 19 years. Will taking the pill now increase my risk?
- Answers - Kutluk Oktay, M.D. The answer that I can give on women with BRCA1 risk is that birth control pills do slightly increase the risk of breast cancer. We’re unaware of specific studies that show whether the BRCA1 gene increases that.
- Leslie R. Schover, Ph.D. It might be relevant that, in general, women with BRCA1 mutations have some of the same increases in breast cancer risk from other hormone factors as women with non-inherited breast cancer.
- Kutluk Oktay, M.D. We know that birth control pills reduce the risk of ovarian cancer, but again, I'm not aware of a specific study looking at BRCA1-positive patients and use of birth control pills to reduce the risk of cancer. Overall, since birth control pills reduce the risk of ovarian cancer it may actually be beneficial in that sense.
- Leslie R. Schover, Ph.D. At age 39, if in your particular family there've been cases of ovarian cancer, you're at an age where they start recommending you get your ovaries removed because it's so hard to screen in order to catch it early enough.
- Kutluk Oktay, M.D. The current recommendation for oophorectomy is between 40 and 45 for someone at high risk. But depending on the family history and how early it developed with family members and whether you've completed your child-bearing, this can be done sooner or later (in general, I mean). One other thing is that there is some evidence that birth control pills reduce the risk in ovarian cancer mutation carriers, but potentially increasing the risk of early-onset breast cancer. So in that sense, it may be a wash. There's also another controversial treatment -- having tubal ligation. Some studies show that having your tubes tied if you're BRCA1-positive may reduce your risk of ovarian cancer. This is also controversial. For a patient like you, if you're still not ready to have children, it might be wise to undergo an in vitro fertilization (IVF) cycle to freeze your embryos. This kind of fertility treatment can even be done with medication such as letrozole (brand name: Femara; an aromatase inhibitor) to reduce the estrogen exposure during fertility treatments.
- Leslie R. Schover, Ph.D. You would have the option of either freezing unfertilized eggs, which has less chance of success later, or, since you have no partner, using sperm from a donor to create embryos because that has a better success rate for pregnancy.
- Kutluk Oktay, M.D. Another advantage of IVF, if in the future you do want to make sure you're not transmitting the gene to your children, is that the embryos (either derived from frozen eggs or donated sperm) can be genetically tested before being transferred back to your womb to make sure they do not carry the mutation. The other thing that I find here, women with BRCA mutations may increase their risk of breast cancer by becoming pregnant before age 40 years, but breastfeeding may decrease that risk somewhat regardless of patient’s age. So clearly there are complex interactions at play, thus issues with a patient with BRCA mutations are complex.
- Leslie R. Schover, Ph.D. If you are considering having bilateral prophylactic mastectomy yourself, like the other women in your family, you may want to do that soon, since you're at the same age that they developed their cancer. And then you would be less at risk to get breast cancer if you had a pregnancy.
- Kutluk Oktay, M.D. The studies did not look at mutations in those patients; these were much earlier studies predating the era of BRCA testing. Currently we don't know if being pregnant after having been treated for BRCA-positive cancer will be as safe as in those women who conceive after BRCA-negative cancer.
On Wednesday, September 10, 2008, our Ask-the-Expert Online Conference was called Fertility and Pregnancy. Kutluk Oktay, M.D. and Leslie Schover, Ph.D. answered your questions about breast cancer treatments that can affect your fertility, options for preserving your fertility, being treated for breast cancer while pregnant, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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