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Can you predict breast or ovarian cancer?

Genetics are what makes each of us individuals — right down to the shade of our hair and the color of our eyes. Passed down from our parents, genes are a true wonder of nature. But not all genes are formed perfectly. Some are mutated or altered. In some cases, this causes them to malfunction and may increase a person's risk of illnesses such as cancer.

An important warning
Research shows that mutations in one of two genes — the Breast Cancer Gene 1 (BRCA 1) and Breast Cancer Gene 2 (BRCA 2) — may increase a woman's risk of early-onset breast cancer.

The good news is that a simple blood test can determine who carries mutations in these genes, and there are programs to help a person decide the best course of action.

Fox Chase Virtua Health Cancer Program offers such a service through its Family Risk Assessment Program for women with a family history of breast or ovarian cancer. The program includes a three-step process of education, counseling and genetic testing. Participants learn about their personal risk factors as well as the latest information on screening and prevention.

Knowledge is power
"Women become empowered by knowing their actual risk of breast cancer," says the program's manager Bridget Legrazie, MSN, RN, AOCN, APN, C. "It allows them to take back some control of the unknown and to take measures to help prevent and reduce their risk of cancer."

Legrazie adds that knowing there is a mutation can be invaluable to more than the person who is tested. The process could also benefit children and grandchildren. She says, "If a woman tests positive, her children have a 50% chance of inheriting the alteration." Men can carry and pass down mutations as well.

Options for positive results
"Woman who carry one of these genetic abnormalities fall into the highest risk category we know for developing breast cancer," explains Diane Gillum, MD, medical director of the Fox Chase Virtua Health Breast Health Program. "If we can identify these women, we can offer them the most advanced screening and treatment in hope of prevention or early diagnosis."

Dr. Gillum, a board-certified surgeon for more than a decade, explains that women who test positive have three basic options. "They can increase surveillance, have prophylactic surgery or take preventive medications."

Increasing surveillance or screening methods may include more detailed mammography as well as ultrasound or possibly magnetic resonance imaging (MRI) of the breast. Since breast cancer is also linked to ovarian cancer, additional screenings are recommended, including pelvic ultrasounds and blood tests for cancer markers.

Depending on the risk level, some women may choose to have prophylactic or preventive surgery. One option is an oopherectomy to remove the ovaries, which can reduce the risk of breast cancer by 50%. Another is mastectomy to remove both breasts, which may decrease a woman's risk by 90%. This is usually done with reconstruction.

Another option is chemoprevention, which uses medications to prevent cancer growth. Those with an increased risk of breast or ovarian cancer on the basis of genetic testing or other factors may choose to take Tamoxifin for breast cancer or oral contraceptives to reduce the risk of ovarian cancer.

Some may even choose to enroll in cancer prevention trials. Currently, the Fox Chase Virtua Health Cancer Program is offering eligible candidates an opportunity to take part in STAR, the Study of Tamoxifen and Raloxifene. This cancer prevention study compares the effectiveness of these two drugs in reducing the risk of breast cancer for postmenopausal women.

Testing those with cancer
Genetic testing can also help those who already have breast or ovarian. Mutations in BRCA1 and BRCA2 genes greatly increase the risk of a second cancer. Maurice Cairoli, MD, medical oncologist at Fox Chase Virtua Health Cancer Program, explains that knowing someone has a genetic abnormality allows the physician to counsel her on the risk of cancer in the other breast or the ovaries as well as to examine prophylactic treatment options.

Dr. Cairoli, who's been in practice for almost 15 years, says that testing negative shouldn't give a false sense of immunity. "A woman who tests negative should still follow cancer screening guidelines."

Learn more
Along with the Family Risk Assessment Program, Fox Chase Virtua Health Cancer Program offers a variety of breast cancer services including state-of-the-art imaging, a second-opinion service and various breast cancer support groups. There are also year-round education programs as well as free breast cancer screenings for the underinsured or uninsured. For more information, call 1-888-Virtua-3.