BRCA1: Options for Managing Risk
Risk Management for People with Inherited Mutations
People with mutations have options for managing their increased cancer risk. Experts at the National Comprehensive Cancer Network (NCCN) created guidelines for people with a mutation to manage their cancer risk.
We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and can help you decide on a plan for managing your risk. Note that when we use "female" and "male" or "women" and "men" we are referring to the sex you were assigned at birth.
NCCN recommends that all people with an inherited mutation receive education on the signs and symptoms of BRCA1-related cancers. NCCN guidelines for specific cancers are listed below.
People with a mutation may also qualify for clinical trials looking for more effective screening or prevention for cancer.
In the News
Study : Yearly breast MRI screening improves outcomes for women with inherited BRCA mutations
An international research study of yearly breast MRI screening among women with BRCA1 and BRCA2 gene mutations found that BRCA1 carriers who had MRI screenings were less likely to die of breast cancer than those...
Beginning Age |
Recommendation |
Additional Information |
18 |
Learn to be aware of changes in your breasts. |
|
25 |
Breast exam by doctor every 6-12 months. |
|
25 (or earlier based on family history) |
Yearly breast MRI with and without contrast beginning at age 25 and continuing until age 75. |
If MRI is not available, mammogram screening should begin at age 25. |
30 |
Yearly mammogram. |
|
No set age |
Discuss the benefits, risks and costs of double mastectomy with your doctor. |
Risk-reducing mastectomy lowers breast cancer risk by 90%, but has not been shown to improve survival. Even after double mastectomy, some breast tissue, and therefore cancer risk remains. |
No set age |
Discuss the benefits, risks and costs of medications to lower the risk for breast cancer with your doctor. |
Tamoxifen or other estrogen-blocking drugs may lower breast cancer risk. Medications or vaccines are being studied in clinical trials. |
75 |
Consider whether to continue, stop or change breast screening. |
|
Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025 |
Beginning Age |
Recommendation |
35 |
Learn how to do a breast self-exam and be aware of changes in your breasts. |
35 |
Breast exam by doctor every 6-12 months. |
50 (or earlier based on the youngest case of male breast cancer in the family) |
Have a discussion with your doctor about the benefits, risks and costs of annual mammograms. |
Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025 |
Beginning Age |
Recommendation |
Additional Information |
35-40 |
Risk-reducing removal of ovaries and fallopian tubes (RRSO). Timing of surgery should take into account plans to have children. |
|
35-40 |
Have a discussion with your doctor about the risks, benefits and costs of removing your uterus (hysterectomy) at the time of RRSO. |
The following factors may affect your decision about hysterectomy at the time of RRSO:
|
Before age 50 |
Experts believe that most ovarian cancers begin in the fallopian tubes. Researchers are studying whether the removal of the fallopian tubes only (salpingectomy), while delaying oophorectomy until closer to the age of natural menopause is a safe option for lowering risk in people who are not ready to remove their ovaries. Guidelines recommend that people interested in this approach speak with their doctor about the benefits and risks, and consider enrolling in a research study. |
|
No set age |
Speak with your doctor about the benefits, risks and timing of oral contraceptives or progestin intrauterine devices (IUD) to lower the risk for ovarian and fallopian tube cancers. |
|
No set age |
Become aware of ovarian and primary peritoneal cancer symptoms. Report to any symptoms that persist for several weeks and are a change from normal to your doctor. Routine ovarian cancer screening using transvaginal ultrasound and a CA-125 blood test has not shown benefit and is not recommended. |
Symptoms of ovarian cancer include:
|
Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025 |
Beginning Age |
Recommendation |
40 |
|
Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025 |
Risk management for pancreatic cancer
There are two tests that are used to look for pancreatic cancer in high-risk people.
- MRCP (Contrast-enhanced magnetic resonance cholangiopancreatography) is a special type of imaging that looks closely at the pancreas, liver, gallbladder, bile duct and pancreatic duct to find abnormalities such as cancer.
- EUS (Endoscopic ) involves passing a tiny scope with an attached probe down the esophagus to the stomach. This allows doctors to look closely at the pancreas.
There are two separate organizations with guidelines related to screening for pancreatic cancer in people with mutations, the American Society of Gastrointestinal Endoscopy (ASGE) and the National Comprehensive Cancer Network (NCCN). The guidelines differ on who should receive screening based on gene mutation and family history.
Organization |
Beginning Age |
Family History |
Recommendation |
ASGE |
50 (or earlier based on the youngest case of pancreatic cancer in the family) |
For BRCA1 mutation carriers regardless of family history of pancreatic cancer |
Annual screening for pancreatic cancer with MRI/MRCP or EUS |
NCCN |
50 (or earlier based on the youngest case of pancreatic cancer in the family) |
For BRCA1 mutation carriers with a first- or second- degree relative with pancreatic cancer |
|
Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025; ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations. Gastrointest Endosc. 2022 May;95(5):817-826. |
Other cancers
Melanoma
NCCN does not include guidelines for melanoma screening for people with mutations. However, some experts recommend general melanoma risk management such as a yearly full-body skin exam, a yearly eye exam and avoiding too much sun exposure.
Other cancer screening and prevention
There has not been enough research to show a benefit from screening and prevention for other cancers in people who have a mutation. For this reason, experts recommend managing these risks based on your family history. Cancer screening and prevention research studies may be available.
Participate in Prevention Research
Below are some of our featured research studies looking at new ways to screen for, prevent or intercept cancer in people with mutations. To search for additional studies, visit our Search and Enroll Tool.
Pancreatic Cancer Screening Study (CAPS5)
Clinicaltrials.gov identifier:
NCT02000089
PATROL Study: Prostate Cancer Screening for People AT Genetic Risk FOr Aggressive Disease
Clinicaltrials.gov identifier:
NCT04472338
Screening Study for Men at High Genetic Risk for Prostate Cancer
Clinicaltrials.gov identifier:
NCT03805919
Testing a Vaccine for Preventing or Treating Triple-Negative Breast Cancer
Clinicaltrials.gov identifier:
NCT04674306
Pancreatic Cancer Early Detection for People at High Risk
Clinicaltrials.gov identifier:
NCT04970056
Screening in Men at High Risk of Developing Prostate Cancer
Clinicaltrials.gov identifier:
NCT05608694
Clinicaltrials.gov identifier:
NCT05287451