By Sara Bienenfeld, MS, LCGC, Genetic Counselor, Cancer Genetics Program

If you're in your 20s and are BRCA positive (read about what it means to have a harmful variant in the BRCA gene), don't panic. Still, you may be wondering what you're supposed to do with this information. Here are some helpful first steps.

1. Visit a Breast Specialist or Breast Surgeon

He or she can help you understand your options and serve as a source of support as you make important health decisions.

• Cancer Prevention Surgery — Some women in their 20s who are BRCA positive may choose to have a double mastectomy—or complete removal of both breasts— and some may not. Your breast surgeon will go over the benefits and risks as well as alternative options (such as a high-risk breast screening).
• Breast Health Specialists — The experts at Stamford Health’s Breast Center know that getting a mastectomy to reduce the risk of cancer is a highly personal decision. That’s why your medical team will respect your wishes either way.

2. Ask Questions

You're your own advocate—you’ve already made an important decision for your health by going in for genetic testing. Keep the following questions in mind so you can make informed decisions:

How do I use the fact that I'm BRCA positive to protect myself?

In your early 20s, breast awareness is key. Talk with your doctor about methods that you can use to be proactive.

How often should I be going in for formal breast screening, and for what type of screening?

Experts recommend the following breast screenings if you're in your 20s and BRCA positive:

• If you have a BRCA1 or BRCA2 harmful variant in your 20s, an annual breast MRI begins at age 25 or 10 years younger than the earliest age of breast cancer diagnosis in your family (if earlier).
• If you’re over 30 and BRCA positive, you should get a mammogram once a year in addition to the breast MRI. These two screenings should switch off every 6 months.
• You should have clinical breast exams at your gynecologist appointment twice a year.

Are you taking oral birth control? If not, would you consider taking it?

If you’re over 20, BRCA positive and concerned about your risk of ovarian cancer, talk to your doctor about oral birth control pills. The pill may reduce your lifetime risk of ovarian cancer by about 50% after five years.

Are you close with your family?

Loaded question, but we want you to know you’re not alone. A harmful variant in a BRCA1 or BRCA2 gene is a hereditary issue, so it’s important for the whole family to understand what it means and to support any decisions you make about your health.

3. Keep Things in Perspective

Remember, a BRCA1 or BRCA2 gene harmful variant is not an automatic cancer diagnosis. It just means you are at higher risk for developing specific cancer such as breast cancer and ovarian cancer.

The first step to proactively managing your breast and ovarian health is having the right team of genetic counselors by your side.

4. Accept What You Can't Control—Change What You Can

We can't change our genetic makeup, but we can influence the stressors that affect the body. Having a healthy lifestyle is important for everyone’s cancer risk reduction, genetic variant or not:

• Commit to quit smoking — Cancer isn’t the only health issue tobacco use causes. It’s never too late to quit. As an added bonus, you can save up to $7,280 a year by quitting. Learn more about how to take the first step and quit smoking. Also, spoiler alert, vaping is not safe either.
• Eat a healthy diet — Everyone has different food preferences, but nutritionists and physicians generally recommend filling your plate with (healthy) colors. You may have heard of the anti-inflammatory or Mediterranean diet. Here’s more on fighting inflammation with food.
• Manage stress — The 20s are a decade of important life decisions like establishing your career or buying a home. These milestones can be overwhelming, so it's important to check in on your stress level. Call upon your network of friends or consider talk therapy.
• Practice mindfulness — There is “noise” all around us. Sometimes we need to turn it off, engage in self-reflection and stay in the present moment. Here are some tips on finding your way through spiritual wellness.
• Stay active — While we’re all for a physical challenge, you don’t need to complete a Tough Mudder or Iron Man—or even run—to be in good physical shape. Establish a regular exercise routine that works for you: a little bit can go a long way.
• Stay safe in the sun — There is a connection between BRCA2 mutations and an increased risk of melanoma. Protect your skin as early as possible from the sun.

Count on the cancer genetic counseling experts in Stamford Health’s Women’s Specialty Center and the Carl & Dorothy Bennett Cancer Center to customize a care plan that answers your questions and meets your needs.