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Genetic mutations

African American and White Women share same genes that increase the risk of breast cancer

The same genes that increase the risk of breast cancer in U.S. White women also greatly increase breast cancer risk among African American women.

These genes include the BRCA1, BRCA2 and PALB2 genes, each of which is associated with a more than seven-fold risk of breast cancer, as well as four other genes associated with a more moderate increase in risk.  Previous studies of women of African ancestry were too small to assess genes other than BRCA1 and BRCA2.

“This means that the multi-gene panels that are currently available to test women diagnosed with breast cancer or women at high risk due to their family history will be useful for African American women,” explains Julie Palmer, ScD, (left) of the Boston University School of Medicine.

Researchers in 2020 sequenced the germline (inherited) DNA from 5,054 African American women with breast cancer and 4,993 age-matched African American women without cancer for mutations in 23 genes linked to a predisposition for cancer. They then estimated the risks of developing breast cancer associated with having a mutation in any of the genes.

Rates of genetic mutations similar between Black and White women diagnosed with breast cancer

In a 2021 study of 3,946 Black women diagnosed with breast cancer and 25,287 White women also diagnosed with the disease, the rates of genetic mutations in genes linked to breast cancer were similar. Among the Black women, 5.65% had a mutation in one of the 12 genes, compared with 5.06% of the White women, a difference that is not statistically different.

The researchers, led by Susan Domchek, MD, (right) of the University of Pennsylvania, concluded that all efforts should be made to ensure equal access to genetic testing to minimize disparities in care and outcomes in women diagnosed with breast cancer.

The study also confirmed that Black women were more likely to be diagnosed with breast cancer at a younger age, more likely to be diagnosed with triple-negative breast cancer, and more likely to be diagnosed with estrogen-receptor-negative breast cancer (which tends to grow faster than hormone receptor-positive cancer).

BRCA1 and BRCA2 genes

About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene changes (mutations) passed on from a parent.  The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer.

If you have inherited a mutated copy of either gene from a parent, you have a higher risk of breast cancer. On average, a woman with a BRCA1 or BRCA2 gene mutation has up to a 7 in 10 chance of getting breast cancer by age 80. This risk is also affected by how many other family members have had breast cancer. It goes up if more family members are affected.

Women with one of these mutations are more likely to be diagnosed with breast cancer at a younger age, as well as to have cancer in both breasts. Women with one of these gene changes also have a higher risk of developing ovarian cancer and some other cancers.  Men who inherit one of these gene changes also have a higher risk of breast, prostate and some other cancers.

In the United States, BRCA mutations are more common in Jewish people of Ashkenazi (Eastern Europe) origin than in other racial and ethnic groups, but anyone can have them.

See: “Breast Cancer Risk Factors You Cannot Change” on the American Cancer Society website

BRCA Genes and Breast Cancer

Without treatment, a woman who is BRCA1 or BRCA2 mutation carrier is seven times more likely to develop breast cancer and 30 more times likely to develop ovarian cancer before the age of 70.

A 3-minute video from the CDC.

Understanding BRCA Mutations and Risk

Everyone has the BRCA genes. Their job is to repair errors that occur in your cell’s DNA. If one or both genes you inherited have a mutation, they might let some errors through.

A 4-minute video from the Dr. Susan Love Foundation.

Dispelling myths of BRCA gene mutations

BRCA mutations have been linked to breast, ovarian, pancreatic and prostate cancers, all of which aside from ovarian cancer, can affect men.

A 4-minute video from AstraZeneca.

Black & BRCA is a collaboration between the Basser Center for BRCA and its team of patient advocates, researchers and healthcare professionals to bring tailored resources and support to the Black community. The Basser Center is part of the University of Pennsylvania Health System, a major multi-hospital health system headquartered in Philadelphia, Pennsylvania.

“At a time when Black men and women are more likely than the general population to be diagnosed with cancer at later stages when it is less treatable, Black & BRCA seeks to empower individuals to understand their family health history and take action to prevent cancer from one generation to the next.”

Educational Resources

My Experience as a BRCA Mutation Carrier

Erika Stallings is a lawyer, writer, and patient advocate based in New York City. In 2014, she learned that she carried a BRCA2 mutation like her mother. 

Despite my risk, I avoided getting tested right away. I was busy living life. Before I knew it, I was 28 years old, about the same age that my mom was first diagnosed.

I knew I needed to get tested. Looking back, I’m a little embarrassed that I pushed it off. But when you’re young, you feel healthy. You don’t expect these huge hurdles to come up, even if you know you’re at risk.

I tried to make an appointment for genetic testing at Memorial Sloan Kettering, but was waitlisted due to a shortage of genetic counselors in the United States. In June 2014, I got an appointment at New York University. I did some volunteer work for a breast cancer organization in New York City, and the executive director helped me get an appointment. If it weren’t for them, I would’ve had to wait another six months.

In July, I got the results. I had inherited the BRCA2 mutation. I knew it.” She underwent a preventative mastectomy later that year.

Source: “My Experience As a BRCA Mutation Carrier”(August 25, 2021)

Recent news about disparities in genetic mutations

Genetic testing

Groups at Higher Risk for Hereditary Breast and Ovarian Cancer

Most hereditary breast cancers are caused by abnormal BRCA1 and BRCA2 genes. However, even if a BRCA1 or BRCA2 gene mutation does not run in the family, a strong family health history of breast cancer makes it more likely that a person will get breast cancer, possibly due to mutations in other genes. Mutations in several other genes also have been linked to breast and ovarian cancers.

The first step in assessing your risk is learning your family history and sharing this information with your health care provider to learn if genetic counseling and testing are right for you.

See more at the Centers for Disease Control and Prevention: “Groups at Higher Risk for Hereditary Breast and Ovarian Cancer”

Testing for the BRCA genes isn’t routinely performed in people with an average risk of breast cancer. It’s usually offered only to those who are likely, based on a personal or family history of cancer, to have an inherited mutation. The identification of a mutation may affect the treatment recommendations, make a patient eligible for certain clinical trials, and alert other members of a family that they may have also inherited the mutated gene.

If your genetic testing was performed prior to 2014, updated testing should be considered. Earlier testing most likely would not have included looking for PALB2 or other potentially relevant genes and may not have included testing for large genomic rearrangements in BRCA1 or BRCA2.

Sources:

One of key reasons to do BRCA testing: to find out if you're at greater risk for ovarian cancer, too

“If you for example have a family history of breast cancer or a personal history of breast cancer, you might not be thinking that you’re at risk for ovarian cancer,” says Susan Domchek, MD, Executive Director, Basser Center for BRCA at the University of Pennsylvania. “But that risk is as high as 45 percent.”

“Ovarian cancer, unlike breast cancer, has no effective screening. It unfortunately usually presents late and most people die of that cancer.

So, it’s a cancer we very much want to prevent. One of the key reasons to do genetic testing is to figure out whether you’re at risk for ovarian cancer and to act on that information.” 

A 3-minute video from Penn Medicine at the University of Pennsylvania

Racial Disparities Persist in Genetic Testing

Carlette Burton knew she had a family history of cancer, but she never looked into her genetic risk for BRCA-related cancer until she found a concerning lump in her breast during a self check. After her diagnosis, she had genetic testing done and found out that she has a BRCA mutation.

Burton’s mother also had been diagnosed with breast cancer in her 30s. Her grandmother had had breast cancer, too. She is one of five sisters, “but I don’t ever recall a doctor saying we should get tested.”

Read more at “Racial disparities still persist in genetic testing for BRCA-related breast cancer” by Tracey Romero on the Philly Voice website (April 6, 2021)

Black women less likely to undergo genetic counseling and testing

About five percent of both Black and white women have a genetic mutation that increases their risk of breast cancer, according to a new study of nearly 30,000 patients. 

However, compared to White women, Black women are much less likely to undergo genetic counseling and testing, largely due to differences in physician recommendations or access to care. 

“Our efforts should focus on ensuring equal access to testing to minimize disparities in care and outcomes,” said researcher Susan Domchek of Penn Medicine at the University of Pennsylvania (June 11, 2021)

Read more at “Black and White Women Have Same Mutations Linked to Breast Cancer Risk” on the Penn Medicine website (June 11 , 2021)

Get Genetic Counseling Before Testing

The Centers for Disease Control and Prevention (CDC) says it’s important to get genetic counseling before genetic testing for hereditary breast and ovarian cancer in order to determine whether you and your family are likely enough to have a mutation that it is worth getting tested. Usually, genetic testing is recommended if you have:

  • A strong family health history of breast and ovarian cancer
  • A moderate family health history of breast and ovarian cancer and are of Ashkenazi Jewish or Eastern European ancestry
  • A personal history of breast cancer and meet certain criteria (related to age of diagnosis, type of cancer, presence of certain other cancers or cancer in both breasts, ancestry, and family health history)
  • A personal history of ovarian, fallopian tube, or primary peritoneal cancer
  • A known BRCA1, BRCA2, or other inherited mutation in your family

Carletta (above) tested negative for BRCA mutations after being diagnosed with breast cancer.

Source: “Genetic Testing for Hereditary Breast and Ovarian Cancer” (CDC)

To find genetic counseling services: 

Source: “Genetic Testing for Hereditary Breast and Ovarian Cancer” (CDC)

Recording your family history

My Family Health Portrait: an online tool from the Surgeon General

Recent news about disparities in genetic testing

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