Who Needs BRCA Genetic Testing For Breast Cancer Risk?
Blond hair, left-handedness or artistic talent are not the only things to run in a family: Cancer risk can be passed down as well.
Cancer can be passed from parents to children through shared DNA, making families more susceptible to illnesses like breast and ovarian cancer. Genetic testing can tell you if you're at risk.
"We're recommending genetic testing more frequently," says Morgan Dally, board-certified genetic counselor with the Hereditary Cancer Program at Franciscan Health. "Knowing about an increased risk helps people be proactive about their health and share valuable information with their families."
Breast and ovarian cancer can run in families and even in people of certain ethnicities, such as Ashkenazi Jews. If you're concerned about your risk level, here's what you need to know:
What Is BRCA?
Cells contain a copy of your genes. Like an instruction booklet, genes tell cells how to build and maintain your body. You inherit one set of genes from each parent, and together, they determine things like hair color, eye color and height.
BRCA stands for "breast cancer gene" and refers to two specific genes – BRCA1 and BRCA2 – that every person has. When working correctly, they help prevent cancer by repairing damaged cells and suppressing tumors. However, specific changes (mutations) to these genes impair their function, making it more likely cancer will develop.
A change in one of these genes increases a woman's ovarian cancer risk by up to 45% and breast cancer risk by up to 85%. There's also an increased risk for prostate cancer and breast cancer in men as well as pancreatic cancer in both men and women. And mutations on the BRCA1 gene increase the likelihood of developing an aggressive, hard-to-treat type of breast cancer.
The U.S. Preventive Services Task Force recommends that primary care doctors screen patients for a family history of breast and ovarian cancer and refer them for genetic counseling when appropriate.
Some criteria include:
- First degree relative with breast or ovarian cancer
- Relatives with bilateral breast cancer
- Male family member with breast cancer
- Female relative with breast cancer before the age of 50
- Two or more family members with breast, ovarian or bowel cancer
The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.
"Ask your primary care doctor if you meet any of these guidelines," says Dally. "But we generally recommend that anybody with a concern about their personal or family history of cancer speak with a genetics counselor."
What Happens During BRCA Testing?
Primary care doctors and OBGYNs often refer people for genetic testing, but you can also self-refer. During the appointment, your genetics counselor will walk you through the following steps:
- Discuss your risk of developing cancer, based on personal and family medical history
- Determine if you meet testing criteria and whether insurance is likely to cover it
- Decide which of the numerous genetic testing options is most appropriate
- Discuss how results will impact medical management and family members
- Perform blood draw or get a saliva sample
- Review results and provide medical recommendations and referrals
What Are The Benefits Of Getting Tested?
Genetic testing can provide information you need to take steps to prevent cancer. You may need earlier or more frequent screening or perhaps lifestyle changes like quitting smoking and maintaining a healthy weight.
"Finding out your risk level can affect your medical management," says Dally. "If you have BRCA1 or BRCA2 mutations, you can start breast cancer screening at a younger age and opt for MRIs in addition to mammograms. You might also consider taking medication to lower your breast cancer risk or opt for an elective mastectomy or hysterectomy."
The law prohibits health insurance companies and employers from discriminating based on a positive test result. However, a positive result could still affect life insurance, long-term care or disability insurance. "If you're concerned, consider getting those insurance policies in place before testing," says Dally.
Are Online BRCA Test Kits Accurate?
Online test kits provide a limited analysis. There are numerous mutations that can be found in the BRCA1 and BRCA2 genes. But over-the-counter test kits only look for three mutations commonly found in the Ashkenazi Jewish population.
If you're interested in genetic testing, a good first step is to find out if your health insurance covers it. "Typically, coverage is pretty good, especially if you meet the testing criteria," says Dally. "Even paying for it out of pocket has become more affordable."
Genetic counselors are experienced in guiding patients through the testing process. Learn more about the cancer genetic testing program at Franciscan Health.