These are common and very understandable concerns. We reached out to experts to help us understand what having a BRCA gene mutation means in terms of having children, and what can be done to lower your child’s risk of cancer down the road.
Breast Cancer and Genetics
Understanding your genetic risk for cancer, and how it can get passed down, can get confusing. Cancer itself can’t be passed down, so if you currently or previously had cancer, you can’t pass it down to your child that way. But cancer can be passed down by way of genetic mutations. These mutations may cause changes in how our cells grow and multiply. One of the most common genetic mutations is on the BRCA gene, which can increase your risk of breast cancer. “We all have the BRCA1 and BRCA2 genes—it’s certain changes in those genes that can increase breast (and other) cancer risks,” explains Sophia Griffith, MS, a cancer genetic counselor in the Department of Hematology and Oncology at the George Washington University Medical Faculty Associates. These genetic changes are passed down in an autosomal dominant pattern, Griffith says. “This means if someone has a changed copy of a BRCA gene, there is a 50% chance they pass that changed copy on to a child,” she explains. This 50% chance is independent of whether or not the parent has had cancer themselves, she adds.
Will I Pass Breast Cancer Down to My Child?
Simply having a BRCA genetic mutation doesn’t mean you will develop breast cancer—it’s just that you have an increased risk. In all, about 13% of people assigned female at birth (AFAB) will be diagnosed with breast cancer in their lifetime. But someone AFAB with a BRCA1 mutation has a 55-72% chance of developing breast cancer by 70 to 80 years old. People AFAB with a BRCA2 mutation have a 45-69% lifetime risk of developing breast cancer. BRCA mutations can also increase breast cancer risks in people assigned male at birth (AMAB). A 2018 study published in BMC Cancer found that while breast cancer in males is rare—a 0.1% risk—it increases among people with BRCA mutations. People AMAB who have a BRCA1 mutation have a 1% lifetime risk of breast cancer, and those with a BRCA2 mutation have a 7-8% lifetime risk. And what if you’ve had cancer yourself? Does this increase the risk of your child having it later in life? The answer is no, says Sandra M. Brown, MS, LCGC, Regional Manager of Genetic Medicine for Providence Southern California in Orange, CA. “The risk over a lifetime is about the same for each mutation carrier,” she explains. “If your offspring has inherited the mutation from you, depending on their sex and age, their risks are approximately the same as yours as they reach stages of adulthood that increase BRCA-associated risks.”
How to Reduce Risk of Breast Cancer
Learning about the increased risk of cancer among BRCA carriers can be stressful, and it’s perfectly normal if you are feeling apprehension as you consider starting your family. But you aren’t powerless. There are actionable steps you can take to reduce risk to yourself and your future children.
Get Tested for BRCA Mutations
Remember, just because you have a BRCA mutation doesn’t mean your child will inherit it. They have a 50/50 chance. But if you know you have the mutation, you should get your child tested. This testing is usually not done until a child turns 18, according to the Centers for Disease Control and Prevention (CDC). You can discuss the timing of testing with a genetic counselor.
Keep Up With Screenings
If you or your child tests positive for BRCA mutations, then you will need to start breast cancer screening earlier than most. “BRCA1 and BRCA2-associated cancer risks can be managed through early and frequent cancer screenings, such as alternating mammograms and breast MRIs every 6 months beginning at age 30,” says Griffith. Some people consider surgeries to reduce risk as well, but this is a very personal decision. “Surgical interventions such as removal of the ovaries and fallopian tubes after childbearing, or a bilateral risk-reducing mastectomy can also help people reduce their cancer risks,” Griffith offers.
Consider “Birth Planning”
Some people with BRCA mutations decide to conceive naturally, but others may benefit from reproductive assistance, says Jessica Jones, MD, an oncologist with McGovern Medical School at UTHealth Houston and an attending physician with Memorial Hermann. “The only way we can know for sure you aren’t going to pass along the gene is if your genes are examined before a pregnancy,” Dr. Jones describes. The way this is done is by having eggs and sperm examined in a laboratory to ensure the ones used at conception do not carry a genetic mutation, she explains. “This process is called ‘birth planning’ and is done with the assistance of fertility specialists,” Dr. Jones says. For example, if you are someone who’s a carrier for a BRCA mutation, you would undergo IVF with a pre-examine egg/sperm embryo, Dr. Jones says. The formal name for this process is preimplantation genetic diagnosis (PGD), and it’s something you can ask your OB/GYN or genetic counselor about.
Consider Your Lifestyle Choices
Whether you have genetic risks or not, there are some lifestyle choices that can have a powerful impact on your health. According to the CDC, the most important steps you can take to reduce risk include refraining from smoking, limiting exposure to secondhand smoke, maintaining a healthy weight, staying physically active, wearing sunscreen regularly, and limiting alcohol consumption.
Seek Support
You do not have to go through this alone, Dr. Jones emphasizes. “With our new advances in medicine, no one feels like they are unfit to have babies just because of their genetics,” she says. “There are resources for patients who have the BRCA gene to help them reach their goals of parenthood, if that is what they desire.” Dr. Jones suggests two resources: Bring Your Brave, which is an outreach program developed by the CDC and FORCE, which offers support meetings and online message boards for people with BRCA mutations.
A Word From Verywell
Every person will have a unique risk profile when it comes to cancer and genetics. If you have increased risk factors, including BRCA mutations, experts recommend connecting with a genetic counselor before you consider pregnancy. Remember that whatever your risk factors are, there are options out there, and there’s a path forward for you to start a happy and healthy family.
