Should I get genetic testing for stage 2 breast cancer at 45?

Question

Hello doctor,

I am 45 years old. I was just diagnosed with stage 2 breast cancer in the left breast, hormone receptor positive, HER2 (human epidermal growth factor receptor 2) negative. Doctors are suggesting lumpectomy with radiation, then hormone therapy.

I am terrified of chemotherapy and its side effects, hair loss, nausea, and weakness. My aunt also had breast cancer in her 40s. Please tell me;

Should I get genetic testing done for the BRCA (breast cancer gene) mutation?
I also wonder if my teenage daughter will have a higher risk.
Are there new targeted medicines with fewer side effects?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is normal to be anxious about treatment and its side effects. In stage 2, hormone receptor–positive, HER2 (human epidermal growth factor receptor 2)-negative breast cancer, the standard approach is exactly what your doctors suggested: surgery (lumpectomy), followed by radiation, and then long-term hormone therapy (such as Tamoxifen or aromatase inhibitors). This lowers the risk of recurrence.

Chemotherapy is not always required. Its use depends on the size of the tumor, lymph node involvement, and results from genomic tests like Oncotype DX, which can predict whether chemo will add significant benefit. Since you have a family history of breast cancer in a close relative at a young age, genetic testing for BRCA1 and 2 (breast cancer gene) and related mutations is strongly recommended. If positive, it would not only influence your treatment choices but also guide screening and prevention strategies for your daughter.

Having a BRCA mutation would increase your daughter's lifetime risk, so early knowledge is empowering for preventive care. As for new treatments, in addition to hormone therapy, there are now targeted medicines such as CDK4/6 (Cyclin-dependent kinase 4 and 6) inhibitors (Palbociclib, Ribociclib, Abemaciclib), which are sometimes added in higher-risk hormone receptor-positive disease and generally have more manageable side effects compared to traditional chemotherapy.

Your doctors can personalize the plan based on your tumor profile, genetic results, and overall health, so you may not necessarily need chemotherapy at all.

I hope this information helps you.

Feel free to ask further queries.

Thank you.