Breast and ovarian cancers have both been linked to mutations in the BRCA1 and BRCA2 genes. Named one of the best doctors for women by Good Housekeeping magazine, Dr. Patricia Braly of Women's Cancer Care in Covington has treated ovarian and breast cancers for more than 30 years. Here, she addresses the link between these cancers and the benefits and misconceptions associated with BRCA genetic testing.
Q: If a woman has been diagnosed with breast cancer, is she more likely to develop ovarian cancer?
A: Breast cancer is very common. It occurs in about one in eight women, so many women with breast cancer do not have an increased risk of ovarian cancer. But the younger patients who develop breast cancer before age 50 do have a potentially significant increased risk. We encourage young patients with breast cancer to undergo genetic testing.
Q: Aside from young women with breast cancer, who else do you encourage to undergo genetic testing for breast and ovarian cancer?
A: Patients with a strong family history of breast or ovarian cancer or those having a relative with bilateral breast cancer (cancer in both breasts). That is a red flag. If you have a family history of cancer or a member with the genetic mutation, you should consider being tested.
Q: What kind of information does the test provide?
A: When we do testing, if the (patients) are positive (for the mutation) we get a report back based on the specific mutation and information as to what their individual risk is for ovarian and breast cancer. It can be as high as 40 to 50 percent for ovarian cancer and as high as 70 to 80 percent lifetime risk for breast cancer.
Q: What is the procedure for BRCA genetic testing?
A: There is only one lab in the country that does it, Myriad (Genetics & Laboratories) in Salt Lake City. You send either a tube of blood or a swab from inside the cheek. It goes to the lab, and the lab checks with the insurance company to see if (the expense) will be covered. It costs around $3,500. Some cover it completely, some not at all. If family members have a (previously identified) BRCA mutation and you want to get tested for just that one mutation, it (costs) considerably less.
Q: How can knowing their lifetime risks for ovarian and breast cancer help patients stay healthy?
A: If a 35- or 45-year-old woman was diagnosed with breast cancer, if she knows she has the mutation, she may very well want to have her ovaries (taken) out. That is called risk-reducing. She may opt for a bilateral (both breasts) mastectomy instead of a unilateral (one breast) mastectomy, because she may have a high chance that she will develop a second breast cancer. With ovarian cancer patients, we routinely take out the ovaries, but with breast cancer patients, it is important for them to know early in their disease process if they are positive for the mutation.
Q: What if patients prefer not to know whether they have the BRCA mutation?
A: Occasionally patients, especially those who have recently been diagnosed with cancer, say they can't concentrate on other issues, so it is not something we push immediately at the time of diagnosis, although it can help patients decide on treatment.
Q: Are there any misconceptions around the BRCA mutation or genetic testing?
A: A lot of people think the only family history that matters is the maternal side, but that is not true. When a man has the mutation, he has an increased risk of breast cancer, which is otherwise rare in men, also (an increased risk) of prostate cancer. One misconception is that patients are afraid to get tested because they think it may have an impact on insurance, but there are federal and state laws preventing using genetic testing information to have a negative impact on insurance or hiring. It is illegal to fire someone because they have a genetic mutation.