Tissue-based breast cancer prevention in people with BRCA mutations
People who have an inherited change in the BRCA1 or BRCA2 gene have a high lifetime risk of developing breast cancer. Breast cancer prevention is especially important for people with these changes.
The two standard options for prevention are:
- Intensive screening, which finds cancer but doesn't prevent it.
- Risk-reducing surgery, which is effective but also removes healthy tissue.
What is missing is a way to tell whether the breast itself has been made safer — that is, whether a prevention strategy is actually changing the at-risk tissue before any cancer forms.
Our lab is working to fill that gap by studying the benign, cancer-free breast tissue of women with BRCA mutations as an active, measurable state rather than as a passive background of risk.
We're studying detailed imaging and molecular profiling of healthy breast lobules. We're working to determine whether this tissue already contains features that put it on a path toward cancer compared with tissue that remains cancer-free. These features may be in the epithelial cells, in the surrounding stroma or in how immune cells are organized around the tissue.
A key part of this work is an expanding resource of tissue samples that we can use for our studies. This resource includes samples from people with BRCA mutations who have breast cancer and those who don't. Comparing these tissue samples lets us begin to separate the states that may signal progression toward cancer from those that simply reflect carrying a BRCA variant. We're pairing this spatial analysis with molecular profiling so that patterns seen in tissue can be connected to the underlying biology.
Our goal is to find practical, measurable changes in breast tissue that suggest whether a cancer prevention approach is having its intended biological effect on tissue that is at risk of developing cancer. Such measurements could make early prevention studies more informative and help move BRCA-related care from estimating risk toward actively intercepting cancer before it begins. This work is in active development, with findings being prepared for publication.