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Breast and Ovarian Cancer Among Individuals Undergoing BRCA1 and BRCA2 Testing
Fahima Dossa1, Kelly Metcalfe2,3, Zharmaine Ante4
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Lifetime cancer risks for women undergoing BRCA testing vary significantly by genetic result and family history. Elevated breast cancer risks were observed even with variants of uncertain significance or negative results, necessitating personalized risk management.
Area of Science:
- Genetics
- Oncology
- Epidemiology
Background:
- Pathogenic variants in BRCA1 and BRCA2 genes significantly increase breast and ovarian cancer risks.
- Risk stratification for female individuals undergoing genetic testing, especially those with variants of uncertain significance (VUS) or negative results, requires further definition.
Purpose of the Study:
- To estimate the lifetime incidence of breast and ovarian cancer in females across all BRCA1/BRCA2 testing result categories.
- To evaluate the modifying effect of family history on these cancer risks.
Main Methods:
- Retrospective cohort study utilizing linked administrative databases in Ontario, Canada (What Comes Next Cohort Study).
- Matched female participants undergoing BRCA1/BRCA2 testing (2007-2016) with general population controls.
- Follow-up until September 2024, with data analyzed from May to December 2025.
Main Results:
- High cumulative breast cancer incidence to age 80 for BRCA1 (62.1%) and BRCA2 (66.1%) pathogenic variant carriers vs. general population (12.0%).
- Elevated ovarian cancer incidence for BRCA1 (56.0%) and BRCA2 (29.3%) carriers vs. general population (1.5%).
- Family history significantly modified risks; VUS and negative results showed increased breast cancer risk (31.2% and 26.3% respectively).
Conclusions:
- Lifetime cancer risks differ substantially based on BRCA testing results and family history.
- Individuals with variants of uncertain significance or negative BRCA test results have elevated breast cancer risks, underscoring the need for individualized risk assessment and management strategies beyond genetic testing alone.
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