Are You Concerned You May Have a Genetic Risk for Cancer?
May 28, 2013
Nelly Oundjian, M.D.
Director, The Valley Hospital Clinical Cancer Genetics Program
Laura Klein, M.D.
Medical Director, The Valley Hospital Breast Center
Gary Breslow, M.D.
Plastic Surgeon, The Valley Hospital Medical Staff
Ridgewood NJ, Angelina Jolie’s decision to have a preventive double mastectomy after learning that she carried a mutation (alteration) in a gene that put her at an 87 percent risk of developing breast cancer highlighted a complex dilemma for women with family histories of breast or ovarian cancer. At issue: a mutation in either the BRCA1 or BRCA2 gene increases the risk of developing breast cancer by as much as 87 percent, and the risk for ovarian cancer by up to 44 percent.
And it’s not just women who are affected. Men with the mutated BRCA2 gene are at increased risk for male breast cancer, and both men and women with the BRCA2 mutation have an increased risk for pancreatic cancer.
So, how do you know if you are a candidate for genetic testing for cancer?
There is no simple list of criteria indicating which individuals should undergo testing. However, those with a strong family history of breast or ovarian cancer, or a personal history of breast, ovarian or pancreatic cancer should consider being evaluated for genetic testing for BRCA mutations. The following additional factors indicate that the probability of detecting a mutation is high enough to warrant consideration of testing:
• A family history of close blood relatives with breast cancer, ovarian cancer and pancreatic cancer, particularly breast cancer diagnosed before age 50
• A family history of male breast cancer
• A BRCA1 or BRCA2 mutation has been discovered in your family
• Your family is of Ashkenazi Jewish descent and there is a family history of breast, ovarian or pancreatic cancer.
The cost for BRCA1 and BRCA2 mutation testing usually ranges from several hundred to several thousand dollars. Insurance policies vary as to whether or not the cost of testing is covered, but most cover the screening for appropriate high-risk patients. If you are considering BRCA1 and BRCA2 mutation testing, you should inquire about your insurance company’s policies regarding genetic tests.
If you do test positive for the BRCA mutation, you have options. These include enhanced cancer surveillance like having Breast MRI alternating with mammograms and breast ultrasound every 6 months and transvaginal pelvic ultrasound, medications to reduce your risk of developing breast cancer, and preventive surgeries, such as prophylactic double mastectomies and removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) after child bearing age.
In our experience, most medical insurance plans will cover the cost of enhanced surveillance and prophylactic and reconstructive surgery in high-risk patients that are carriers of the BRCA mutation.
Valley recently launched the Clinical Cancer Genetics Program to offer comprehensive cancer risk assessment, cancer genetic counseling, and predictive genetic testing to individuals with a personal and/or family history of cancer. If you want for more information or to schedule a consultation to determine if you are a candidate for BRCA screening, please call 201-327-8765.