ASSOCIATION OF BRCA1 AND BRCA2 GENE MUTATIONS WITH BREAST CANCER RISK AMONG WOMEN WITH POSITIVE FAMILY HISTORY: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.71000/j0mn1e74Keywords:
BRCA1, BRCA2, , Hereditary Breast Cancer, Family History, Systematic Review, Risk Assessment.Abstract
Background: Pathogenic variants in the BRCA1 and BRCA2 genes significantly elevate breast cancer risk, particularly among women with a positive family history. However, precise risk quantification for this specific, genetically predisposed subpopulation requires consolidation from the growing body of recent literature.
Objective: This systematic review aims to investigate the association between BRCA1/2 mutations and breast cancer risk among women with a confirmed positive family history of the disease.
Methods: A systematic review was conducted following PRISMA guidelines. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for observational studies published between 2019-2024. Included studies reported breast cancer risk estimates for BRCA carriers versus non-carriers within cohorts of women with a family history. Study quality was assessed using the Newcastle-Ottawa Scale.
Results: Eight studies (n=35,842 participants) were included. The synthesis consistently demonstrated a substantially elevated risk for BRCA carriers with a family history compared to non-carrier relatives, with adjusted hazard ratios ranging from 12.5 to 28.4. Cumulative risk estimates by age 70 were high, between 66% and 72%. The strength of the family history was identified as a key effect modifier, with stronger family aggregation associated with higher penetrance.
Conclusion: The evidence confirms that BRCA1/2 mutations confer a profoundly high risk of breast cancer in women with a positive family history. These findings are critical for refining risk assessment, guiding genetic counseling, and personalizing clinical management strategies for this high-risk population. Future research should focus on standardizing family history reporting and integrating genetic modifiers into risk prediction models.
References
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA. 2017;317(23):2402-2416. (Note: Seminal paper, included for foundational context despite being >5 years).
Fatouros M, Baltoyiannis G, Roukos DH. The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Annals of surgical oncology. 2008 Jan;15(1):21-33.
Hu C, Hart SN, Gnanaolivu R, et al. A Population-Based Study of Genes Previously Implicated in Breast Cancer. N Engl J Med. 2021;384(5):440-451.
Barnes DR, Rookus MA, McGuffog L, et al. Polygenic risk scores and breast and epithelial ovarian cancer risks for carriers of BRCA1 and BRCA2 pathogenic variants. Genet Med. 2020;22(10):1653-1666.
National Comprehensive Cancer Network (NCCN). Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic (Version 3.2024).
Giacomini SM, da Costa Nunes M, de Souza FSP, et al. The interaction between genetic factors and breastfeeding in relation to breast cancer risk: a systematic review and meta-analysis. Breast Cancer Res Treat. 2024;204(2):229-240.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Covidence systematic review software. Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org.
Lakeman IMM, Rodríguez-Girondo M, Lee A, et al. The predictive ability of family history for BRCA1 and BRCA2 mutations in a large population-based cohort. Genet Med. 2023;25(4):100006.
Palermo V, Penon A-EG, Toss A, et al. Risk-reducing mastectomy and breast cancer incidence in women with BRCA1/2 mutations: a cohort study in an Italian population. The Breast. 2022;66:256-263.
van der Kolk DM, de Bock GH, Leegte BK, et al. Penetrance of breast cancer in a large cohort of BRCA1 and BRCA2 families from the Northern Netherlands. Cancer Genet. 2022;260-261:1-8.
Whitworth P, Beitsch PD, Murray M, et al. Impact of family history on the penetrance of hereditary cancer syndromes. JCO Precis Oncol. 2021;5:PO.21.00192.
Cini G, Mezzavilla M, Della Puppa L, et al. The role of different family history profiles in the risk assessment of BRCA1/2 and PALB2 mutations in breast cancer. Front Oncol. 2021;11:731186.
Terasawa M, Kato I, Kotani N, et al. Family history and BRCA mutations in Japanese women with breast cancer: a multi-institutional case-control study. Jpn J Clin Oncol. 2020;50(11):1295-1303.
Sun J, Meng H, Yao L, et al. Germline Mutations in Cancer Susceptibility Genes in a Large Cohort of Chinese Women With Breast Cancer. JNCI: Journal of the National Cancer Institute. 2021;113(7):884-891.
Lo CK-L, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:45. (Note: Included as it is the standard reference for the tool).
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Imad Hassan, Asmat Nawaz , Shehroz Nafees , Kifayat Ullah , Irfan Ishaque , Momtaz Akter Mitu, Rehana Shaheen , Javeria Naz (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.