Should I pursue genetic testing to determine my risk of breast cancer?
Your grandmother and mother had breast cancer. Does this mean you also will get breast cancer?
Here is the good news: only about 5 percent to 10 percent of cancers are related to family history.
Here is more good news: receiving information, resources and advice may help relieve your anxiety, and also empowers you to make an educated decision about your breast health.
Here is what you should know:
All cancers are caused by changes to materials in our bodies called genes. When genes are damaged, they can develop changes called mutations. Over time, damage can accumulate in cells, causing them to grow out of control, causing cancer.
Some people are born with a gene mutation they inherited from their mother or father. This damaged gene places them at higher risk for cancer than most people.
A woman’s lifetime risk of developing breast or ovarian cancer is greatly increased if she inherits a harmful mutation in the BRCA1 or BRCA2 gene. If you have a high-risk gene mutation, your children have a 50 percent chance of having the mutation. Other family members may also be at risk for having the same mutation.
Most women who have a BRCA1 or BRCA2 genetic mutation have up to an 87 percent chance of developing breast cancer.
While BRCA1 and BRCA2 gene mutations may increase your risk of developing breast cancer, your odds of having either mutation are pretty small. An estimated 0.25 percent of the general population carries a mutated BRCA gene. Even if an abnormal gene linked to a higher breast cancer risk is present in your family, not every person in the family will inherit it.
There is evidence that, over the long term, women who carry these mutations are more likely to develop a second cancer in either the same breast or the opposite breast than women who do not carry these mutations. Thus, some women with a harmful BRCA1 or BRCA2 mutation who develop breast cancer in one breast opt for a bilateral mastectomy, even if they would otherwise be candidates for breast-conserving surgery.
If you learn you have a family member with a gene linked to breast cancer, don’t panic. Most breast cancer cases aren’t genetic.
Are you a candidate for genetic testing?
The best way to decide if your cancer or the cancer in your family is caused by an inherited mutation is to consult a genetics expert who will help you determine if genetic testing is appropriate for you. A genetic counselor will obtain a detailed family and medical history, assess your risk of developing cancer, discuss risks and benefits of genetic testing, and outline your options.
You may be a candidate for genetic testing if you or a relative have had any of the following:
- a personal history of breast cancer at age 45 to 60 and a close family member diagnosed with breast cancer or aggressive prostate cancer at any age
- a personal history of breast cancer at any age and two or more close family members diagnosed with breast cancer at any age
- a personal history of breast cancer at any age and a close family member diagnosed with pancreatic cancer or metastatic prostate cancer at any age
- a relative with a known BRCA1 or BRCA2 mutation
- a close family member diagnosed with breast cancer at age 45 or younger
- ovarian, fallopian tube, or primary peritoneal cancer
- two separate breast cancers
- a personal history of triple negative breast cancer diagnosed at age 60 or younger
- male breast cancer
- pancreatic cancer
- prostate cancer at age 55 or younger or metastatic prostate cancer
- Eastern European Jewish ancestry and any of the above cancers at any age
Testing for BRCA1 and BRCA2 gene mutations requires a simple blood draw or saliva sample. Comprehensive Breast Care can take saliva samples in the office.
Is genetic testing expensive?
Most health insurance plans will cover the cost of genetic counseling as well as BRCA1 and BRCA2 testing if a person meets particular criteria indicating that hereditary cancer might run in the family. A genetic counselor can determine if your insurance will cover genetic testing and help the process go smoothly.
Historically, the cost of genetic testing was as high as $4,000, but the cost has gone down significantly through the years. Costs now can be as low as $250.
A genetic counselor also can help determine if you qualify for a financial assistance program to cover the cost of genetic testing.
If you test positive for a BRCA gene mutation, there are some options to help lower your risk of developing breast cancer. These include enhanced screening, prophylactic (risk-reducing) surgery, and chemoprevention.
Enhanced screening. Some women who test positive for BRCA1 and BRCA2 mutations may choose to start breast cancer screening at a younger age, have more frequent screenings, and use advanced breast imaging modalities such as MRI in addition to a mammogram. Your physician at Comprehensive Breast Care will meet with you to discuss the best plan for you.
Prophylactic (risk-reducing) surgery. Prophylactic surgery involves removing as much of the “at-risk” tissue as possible. Women may choose to have both breasts removed to reduce their risk of breast cancer. It is a very aggressive approach, but can reduce a woman’s risk of getting breast cancer by as much as 95 percent. Your doctor at Comprehensive Breast Care will discuss this option thoroughly so you can determine the best choice for you.
Chemoprevention. Chemoprevention is the use of medicines to try to reduce the risk of cancer. Two chemopreventive drugs (tamoxifen and raloxifene) have been approved by the US Food and Drug Administration (FDA) to reduce the risk of breast cancer in women at increased risk. These drugs can reduce the risk of developing breast cancer by up to 50 percent.
The choice to have genetic counseling and proceed with genetic testing is one to be taken seriously. Though it can sound simple to be tested, there are many things to consider before making this decision. The clinical team at Comprehensive Breast Care will help guide you through the entire process so you understand the pros and cons of genetic testing.
Remember, having a BRCA1, BRCA 2 or other mutation that increases breast cancer risk doesn’t mean you will get breast cancer. Some people with a mutation will never get breast cancer. And, people without a mutation are still at risk. Most women who develop breast cancer don’t have an inherited gene mutation or a family history of breast cancer.
Also remember, just because one family member has a mutation doesn’t mean everyone in the family does.
Eric Brown, MD; and Linsey Gold, DO, are co-authors of a published research paper on a recent landmark study regarding genetic testing, and are happy to discuss the options with you. You can reach them at Comprehensive Breast Care, 248.687.7300.
About the Authors
Eric Brown, MD, FACS, has been caring for breast patients for 20 years. He is board certified in General Surgery and certified in Breast Ultrasound. He previously served as Director of Oncology Services at Beaumont Hospital in Troy, and also as Director of the Center for Breast Health at Beaumont – Troy. Dr. Brown is an Assistant Professor of Surgery at the William Beaumont Oakland University School of Medicine. He is actively involved in research and serves as the Co-Principle Investigator of the Beaumont Cancer Institute Clinical Oncology Research Program. He was voted top breast cancer doctor for 2015 by Newsweek Magazine, and has been named a “Top Doc” for Metro Detroit by Hour Detroit Magazine for the past eight years.
Linsey Gold, DO, FACOS, FACS, is a fellowship trained breast surgeon who has been caring for breast patients since 2006. She has been certified in Breast Ultrasound since 2007. She was named the first Director of the Comprehensive Breast Center at Genesys Regional Medical Center in 2006 where she served for three years. After that, she opened her own private practice – the Michigan Center for Breast Health. She is actively involved with the American Society of Breast Surgeons and is an investigator and participant in a number of clinical trials, under the oversight of the National Cancer Institute. Dr. Gold serves on several national breast cancer organizations including the Breast Surgery Fellowship Site Review Committee, where she has been representing the American Society of Breast Surgeons since 2007.
Dr. Brown and Dr. Gold work at Comprehensive Breast Care at 4967 Crooks Road in Troy. To reach the physicians, call 248.687.7300.