Comparing options & Making Your Decision

It is important to remember that making a decision about which (if any) risk management option(s) to choose is not urgent and you should take your time to consider the advantages and disadvantages (pros and cons) of each option as well as your own personal circumstances and values.

This section of the decision aid will help you to compare your options and work through your own feelings and values.

Options to manage breast cancer risk

1.     Breast Surveillance alone
2.     Risk-reducing medication (chemoprevention) with Breast Surveillance
3.     Surgical removal of breasts (Risk-reducing bilateral mastectomy)

Click below to learn more and compare options.

Breast Surveillance

Surgical removal of breasts

What is involved?

  • Clinical breast exam (where a doctor or nurse examines your breasts) every 6-12 months starting at age 30
  • Breast MRI every year between ages 30-50 (sometimes longer if breasts are dense)
  • Mammogram every year between ages 40-70
  • Breast self-examination (where you check your own breasts) every month

What is involved?

  • An operation to remove your breasts (mastectomy)
  • Reconstruction of breasts can be performed during the same operation or later during another operation
  • Hospital stay up to several days (may be shorter if reconstruction is not performed)
  • About 6 weeks recovery time

What are the advantages ‘Pros’

  • Non-invasive
  • You keep your breasts
  • Usually detects breast cancers at an early stage
  • BRCA2 alteration carriers who choose surveillance have similar survival to those who choose to have their breasts surgically removed

What are the advantages ‘Pros’

  • Reduces risk of BC by 90-95%
  • May reduce worry about getting breast cancer
  • Women can usually choose to have their breasts reconstructed (during the same operation or at a later stage) to restore the appearance of breasts

What are the disadvantages ‘Cons’

  • Does not prevent cancer
  • Possible anxiety about developing breast cancer
  • Even if surveillance detects breast cancer early, treatment such as chemotherapy may still be required
  • False positives can cause unnecessary worry
  • BRCA1 alteration carriers who choose surveillance may have poorer survival to those who choose to have their breasts surgically removed

What are the disadvantages ‘Cons’

  • Surgical complications such as infection, bleeding, blood clots
  • About 6 weeks recovery time
  • Body image issues
  • Cannot breastfeed
  • A very small risk of developing breast cancer still remains

Weighing up your options- what factors are most important to you?

Surveillance and surgical removal of breasts are both considered valid options for managing breast cancer risk in women with a BRCA alteration. This can make deciding between these two options difficult. This decision is personal and different women will have different reasons for choosing one option over the other. Your decision may change over time. For example, some women may decide to choose surveillance now and think about surgery later, after they have had children and have finished breastfeeding.

Taking the time to consider the below statements may help you to clarify what factors matter most to you in making this decision.

Statement Ranking Activity

Rank the following statements from 1 to 10 in order of importance to you giving the statement that you agree with most 1 and the statement that you agree with least 10

Hover your mouse over the  ⓘ  symbol for more information
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Risk-reducing medication (Chemoprevention)

Surgical removal of breasts

What is involved?

  • Taking a tablet every day for 5 years
  • You will also have regular surveillance scans (MRI or mammogram) until age 70

What is involved?

  • An operation to remove your breasts (mastectomy)
  • Reconstruction of breasts can be performed during the same operation or during another operation at a later stage
  • Hospital stay up to several days (may be shorter if reconstruction is not performed)
  • About 6 weeks recovery time

What are the advantages ‘Pros’

  • Reduces BC risk by ~30-40% in high-risk women
  • You keep your breasts

What are the advantages ‘Pros’

  • Reduces risk of BC by 90-95%
  • May reduce worry about getting breast cancer
  • Women can usually choose to have their breasts reconstructed (during the same operation or at a later stage) to restore the appearance of breasts

What are the disadvantages ‘Cons’

  • limited evidence in BRCA alteration carriers specifically
  • May be more suitable for BRCA2 carriers than BRCA1 carriers
  • Not as effective as surgery
  • Increased risk of blood clots (T & R)
  • Increased risk of endometrial cancer (T)
  • Increased risk of osteoporosis (AI)
  • May cause Hot flushes
  • Not suitable for use during pregnancy or while trying for a baby
  • Cannot take while on the oral contraceptive pill (OCP)
  • You will still need regular surveillance scans (MRI or mammogram) until age 70

What are the disadvantages ‘Cons’

  • Surgical complications such as infection, bleeding, blood clots
  • About 6 weeks recovery time
  • Body image issues
  • Cannot breastfeed
  • A very small risk of developing breast cancer still remains

T = tamoxifen, R = raloxifene, AI = Aromatase inhibitor

Weighing up your options- what factors are most important to you?

Risk-reducing medication and surgical removal of breasts are both considered valid options for reducing breast cancer risk in women with a BRCA alteration. It is important to note that taking risk-reducing medication does not replace the need for surveillance. Therefore, women who choose to take risk-reducing medication to lower their breast cancer risk will still need regular MRI scans or mammograms.

Deciding between these options can be difficult. This decision is personal and different women will have different reasons for choosing one option over the other.

Taking the time to consider the below statements may help you to clarify what factors matter most to you in making this decision.

Statement Ranking Activity

Rank the following statements from 1 to 11 in order of importance to you giving the statement that you agree with most 1 and the statement that you agree with least 11

Hover your mouse over the  ⓘ  symbol for more information
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I am not willing to take a medicine that increases my chance of getting uterine cancer even if it reduces my chance of getting breast cancer

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Surveillance alone

Risk-reducing medication (chemoprevention) with Surveillance

What is involved?

  • Clinical breast exam (where a doctor or nurse examines your breasts) every 6-12 months starting at age 30
  • Breast MRI every year between ages 30-50 (sometimes longer if breasts are dense)
  • Mammogram every year between ages 40-70
  • Breast self-examination (where you check your own breasts) every month

What is involved?

  • Taking a tablet every day for 5 years
  • You will also have:
  • regular surveillance scans (MRI or mammogram) until age 70
  • Clinical breast exam (where a doctor or nurse examines your breasts) every 6-12 months starting at age 30
  • Breast self-examination (where you check your own breasts) every month

What are the advantages ‘Pros’

  • Non-invasive
  • You keep your breasts
  • Usually detects breast cancers at an early stage
  • BRCA2 alteration carriers who choose surveillance have similar survival to those who choose to have their breasts surgically removed

What are the advantages ‘Pros’

  • Reduces BC risk by ~30-40% in high-risk women
  • You keep your breasts

What are the disadvantages ‘Cons’

  • Does not prevent cancer
  • Possible anxiety about developing breast cancer
  • Even if surveillance detects breast cancer early, treatment such as chemotherapy may still be required
  • False positives can cause unnecessary worry
  • BRCA1 alteration carriers who choose surveillance may have poorer survival to those who choose to have their breasts surgically removed

What are the disadvantages ‘Cons’

  • limited evidence for chemoprevention in BRCA alteration carriers specifically
  • May be more suitable for BRCA2 carriers than BRCA1 carriers
  • Not as effective as surgery
  • Increased risk of blood clots (T & R)
  • Increased risk of uterine cancer (T)
  • Increased risk of osteoporosis (AI)
  • May cause Hot flushes
  • Not suitable for use during pregnancy or while trying for a baby
  • Cannot take while on the oral contraceptive pill (OCP)
  • You will still need regular surveillance scans (MRI or mammogram) until age 70

T = tamoxifen, R = raloxifene, AI = Aromatase inhibitor

Weighing up your options- what factors are most important to you?

Deciding between surveillance alone and risk-reducing medication (chemoprevention) combined with surveillance can be difficult. This decision is personal and different women will have different reasons for choosing one option over the other. Your decision may change over time. For example, some women may decide to choose surveillance alone now and think about adding risk-reducing medication later or they may choose to try medication (chemoprevention) now and stop taking it at a later stage if they develop undesirable side effects.

Taking the time to consider the below statements may help you to clarify what factors matter most to you in making this decision.

Statement Ranking Activity
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Rank the following statements from 1 to 7 in order of importance to you giving the statement that you agree with most 1 and the statement that you agree with least 7

Hover your mouse over the  ⓘ  symbol for more information
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I am very worried about dying from breast cancer  ⓘ

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Write any questions/concerns in the space provided (you can print this and bring them along to your appointment):



Options to manage ovarian cancer risk

There is currently only one valid option available to manage your ovarian cancer risk. This is surgical removal of your ovaries and fallopian tubes. Therefore, your choice is between undergoing this surgery or choosing to not have ovarian surgery.

Click below to learn more .

Surgical removal of ovaries & fallopian tubes

No ovarian surgery

What is involved?

  • An operation to remove your ovaries and tubes
  • Go home from hospital on same day if you have keyhole surgery (most common)
  • 1-2 night hospital stay if you require open surgery

What is involved?

  • No ovarian surgery or procedures

What are the advantages ‘Pros’

  • Reduces risk of OC by about 85%
  • May reduce worry about getting ovarian cancer

What are the advantages ‘Pros’

  • You will go into menopause at your normal time
  • You can still get pregnant if you are of childbearing age

What are the disadvantages ‘Cons’

  • You will go into menopause immediately
  • You may experience menopausal symptoms such as hot flushes, vaginal dryness, lower libido and well as an increased risk of heart disease and osteoporosis.
  • You will no longer be able to get pregnant
  • There is a small chance that you could still develop cancer of the abdomen lining

What are the disadvantages ‘Cons’

  • Your risk of developing ovarian cancer will remain high

Weighing up your options- what factors are most important to you?

Even though surgical removal of ovaries and fallopian tubes is recommended for women with a BRCA alteration between ages 35-40 for BRCA1 and by age 40-45 for BRCA2 this may not be the right choice for every woman. Deciding whether to have your ovaries removed can be difficult. This decision is personal and different women will have different reasons for choosing whether or not to have this surgery. Your decision may change over time. For example, some women may decide to delay this surgery for now until they are certain that they have finished having children and reconsider having surgery later.

Taking the time to consider the below statements may help you to clarify what factors matter most to you in making this decision.

Taking the time to consider the below statements may help you to clarify what factors matter most to you in making this decision.

Statement Ranking Activity

Rank the following statements from 1 to 7 in order of importance to you giving the statement that you agree with most 1 and the statement that you agree with least 7

Hover your mouse over the  ⓘ  symbol for more information

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I want to do everything I can to reduce my chance of getting ovarian cancer even if that means having surgery and going into early menopause  ⓘ 

I worry constantly about developing ovarian cancer to an extent that it affects my day-to-day life  ⓘ 

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Write any questions/concerns in the space provided (you can print this and bring them along to your appointment):