What are my options for cancer prevention?

Lifestyle

While these won’t stop you from developing breast/ ovarian cancer, there are a number of lifestyle related factors that can help lower your risk. These include:

  • Using the oral contraceptive pill
  • Breast feeding
  • Maintaining a healthy weight
  • Eating a healthy, balanced diet
  • Exercising regularly
  • Not smoking

Ovarian cancer

Surveillance

There is currently no national screening programme for ovarian cancer and surveillance isn’t routinely offered. This is because there is uncertainty about its effectiveness. However, it may be possible to have regular CA125 blood tests and pelvic ultrasound scans. Talk to your GP to find out what is available locally.

Surgery

If you have a BRCA mutation you may have the option of having surgery to remove your ovaries and fallopian tubes (bilateral salpingo-oophorectomy), which will reduce the risk of cancer developing. As well as reducing your risk of developing breast cancer (the precise risk reduction is a matter of debate), having your ovaries and fallopian tubes removed will reduce your risk of developing ovarian cancer to 5%. If you are pre-menopausal, this operation will put you into immediate menopause. There are significant risks associated with going through the menopause early, even if HRT can be taken, so speak to your medical team in detail about this option.

The evidence suggests that the most appropriate age to have this surgery differs depending on your mutation. If you have a BRCA1 mutation, the suggested age for this is 35-40. If you have a BRCA2 mutation you should consider this surgery by the age of 45. 

Another option you may be given is to have a risk-reducing salpingectomy (removing the fallopian tubes only) as evidence suggests that the majority of BRCA1/2-associated ovarian cancers start at the end of the fallopian tube.

However, while evidence from the general population suggests that removing tubes approximately halves risk of ovarian cancer, there is not yet any evidence of safety or efficacy of this approach in women with BRCA1/2 gene mutations. Current research suggests that it offers less protection than removing the ovaries too. 

The advice from the Royal College of Obstetricians and Gynaecologists is that if you have finished your family, are not yet at the age where you wish to have your ovaries removed, but are planning to have an abdominal surgery or sterilisation, it may be worth speaking to your medical team about the options to remove your fallopian tubes at the same time. This should not be in place of removing your ovaries at a later date, but may offer you some risk reduction in the interim.

Lynch Syndrome: As Lynch Syndrome gives a woman an increased risk of uterine cancer as well as ovarian cancer, it is recommended that women with Lynch Syndrome have a total hysterectomy in addition to the bilateral salpingo-oophorectomy between the ages of 40-45.

Breast Cancer

Surveillance

Breast awareness: As all men and women should, individuals with BRCA1 or BRCA2 mutations should get into a regular habit of checking their breasts. Click here for details of how to check your breasts and what signs to look out for.

If there are any changes at all you should visit your GP. 

Women with a BRCA1/2 gene mutation are offered yearly MRI scans, from the age of 30, to check for breast cancer. 

Mammograms are offered annually from age 40–70.

Breast screening will not stop you from getting breast cancer, but it will help to detect any abnormalities early. 

Chemoprevention (medication to prevent cancer)

If you are at high risk of breast cancer but haven’t had it, you can now be treated with a five-year course of tamoxifen or raloxifene to reduce your risk. This treatment carries side effects and risks so you should consult with your medical team to fully understand the implications. 

See NICE guidelines here.

Breast Surgery

If you have a BRCA1/2 mutation, you should be offered the opportunity to have a risk-reducing bilateral mastectomy, which will reduce your breast cancer risk to 5-10%. 

This involves the removal of the breast tissue on both sides, with the option to have your breasts reconstructed. Reconstruction can be done using implants or by using tissue from another part of your body to create new breasts.

This is a major surgery and it involves a great deal of consideration so please discuss all your options with your medical team. It is also wise to get in touch with other women who have been through a similar procedure to find out the advantages and disadvantages. 

Breast Cancer Care provides a support service matching people to others in a similar situation should you wish to speak about their experiences. Find out more.

Men and Breast Cancer

There is no routine breast screening for men with a BRCA1/2 gene mutation as it has not been found to be beneficial.

The advice is to self-examine regularly, and to be aware of any changes. Visit your GP if you have any concerns. If necessary, your GP will refer you to a breast clinic where you will be offered diagnostic tests such as a mammogram, ultrasound and biopsy.  

Lynch Syndrome – additional information

Bowel screening

People with Lynch Syndrome will be advised to attend bowel screening from the age of 25. This will involve a colonoscopy to examine the bowel for any abnormalities, biopsies and the removal of any growths (polyps) that are found.                           

Medication 

Aspirin: there is some evidence that regular doses of aspirin can help reduce the chances of cancer in Lynch Syndrome patients. However, research isn’t conclusive on the best dosage of aspirin to take in this case so we do not advise taking aspirin without consulting your medical team. Please speak to your GP.

It’s important to note that none of these options guarantee that you will not get cancer and there will always be a risk. You should continue to be aware of any changes in your body and visit your GP if you notice anything that concerns you.  Speak to your medical team to understand more.

It’s also important to note that there are no right or wrong decisions. You should take the time to find out as much as possible and make the best decision for you and your family. 

These are NHS England guidelines (also followed in Wales). For specific information about genetic testing in England, Wales and Scotland, please download:

If you have any questions please contact Jo@ovarian.org.uk