In 2010, history was made with a successful effort to pass a Congressional resolution declaring the first-ever National Hereditary Breast and Ovarian Cancer (HBOC) Week and National Previvor Day. The goal of HBOC Week and Previvor Day is to raise awareness about hereditary cancer. HBOC Week marks the transition between National Ovarian Cancer Awareness Month and National Breast Cancer Awareness Month. It recognizes anyone affected by hereditary breast, ovarian and related cancers, including people with BRCA mutations, people with a family history of cancer, breast and ovarian cancer survivors, and previvors —individuals who carry a strong predisposition to cancer but have not developed the disease. Millions of people carry an inherited BRCA mutation or have a family history of cancer but many don’t know about their risk.
All cancers are caused by changes to critical molecular structures in the body called genes. These changes are known as mutations, or abnormalities, and they may be caused randomly, by outside influences such as pollution, smoking or sun exposure, or because they were inherited through the family line. Not everyone who is born with a gene mutation will develop cancer. Inherited gene mutations may be passed from either parent and may increase the cancer risk in both women and men. The risk from inherited gene mutations varies greatly, depending on the abnormality and other factors.
Some women have genes with mutations inherited by one or both parents, that increases the risk of breast cancer. Inherited mutations known to increase the risk of breast cancer are rare in the general population, accounting for about 10 percent of all breast cancers diagnosed in the United States. Some slightly increase breast cancer risk, while others (such as BRCA1 and BRCA2) greatly increase the risk.
Back in the Day…
I think back to the conversations we used to have with patients in the early 2000s, about their family and personal family histories of breast and ovarian cancers and options for genetic testing and compare it to the conversations we have now, and the change is dramatic. In the past, when we offered diagnostic genetic testing to the few who qualified for testing, the test was extremely cost prohibited, most of the time it was not covered by insurance, and the results took months to report and didn’t even screen for multiple types of genes. Providers weren’t sure what to tell patients about their familial risk if they had a normal BRCA1/2 test and they didn’t even know how best to screen these high-risk patients for cancers. In the past, BRCA status wasn’t relevant to a patients treatment plan and oftentimes genetic testing was an afterthought, with referrals often happening due to requests from a patient’s relatives, concerned about their risks.
Today…
Now, oncologists are offering BRCA1/2 testing at the point of the cancer diagnosis because a patient’s BRCA status is an important consideration with regard to planning treatment, understanding their prognosis, their future risk of cancer and options for drug trials. The tests are now relatively inexpensive and quick so the results can be used in real time. Also, patients as well as their providers are now much better informed about genetic testing than they were fifteen years ago. Patients are now expecting to be offered testing or have a discussion about it with their providers and their BRCA understanding is generally very good. It’s no longer feasible to wait until after treatment is complete to offer genetic testing.
Here at Nore Women’s Health, patients will talk to their providers about their genetic risk for breast, ovarian, and colon cancer and be assesses on their personal and family risk factors. Based on these risk factors, we offer patients a simple and quick blood test to assess their risk as well as recommend further counseling with a geneticist as the need arises.
With October being Breast Cancer Awareness Month it is also important to remember to get your screening mammogram. A yearly mammogram is still the gold standard for detecting breast cancer. Please come see us to get an order for your annual mammogram and to discuss if you are at risk for a genetic mutation and can qualify for fast, easy genetic testing.
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