BRCA awareness surges

Celebrities and media have likely played a role in boosting awareness about genetic testing for abnormal breast cancer genes.
A clinical genetic specialist can sift through your family medical history to determine what type of testing will be most useful. (For Spectrum Health Beat)

Celebrity agenda-setting and outsized news coverage over the past decade have led to sizable spikes in the number of women turning to genetic testing to screen for breast cancer.

Much of the heightened media coverage has centered on hereditary breast cancer, particularly the BRCA1 and BRCA2 genes.

Overall, BRCA testing increased 80-fold from 2003 to 2014, with a noticeable surge occurring in 2013, according to University of Georgia researchers. That’s the year Hollywood actress Angelina Jolie published an op-ed in The New York Times promoting BRCA gene testing.

Also that year, the Supreme Court struck down a company’s patent on BRCA gene testing. The decision to overturn the Myriad Laboratories patent on the BRCA genes allowed other labs to start offering the tests, which helped drive down the price.

“Though there was some initial concern about how accurate results would be from other laboratories, we now have several years of data which have helped alleviate those fears,” said Caleb Bupp, MD, a medical geneticist with Spectrum Health Medical Genetics.

Cost has always been a concern, as these tests typically range anywhere from about $500 to $5,000, though some laboratories have pricing even lower. Every insurance plan is different, and some plans require you to meet with a genetic counselor before testing is approved.

The genetic counselor helps patients ensure insurance coverage and verify out-of-pocket costs before having genetic testing performed. The testing can also now be done using saliva instead of requiring a blood draw.

Red flags

The reality is that most women don’t have a hereditary breast cancer. Researchers suspect that about 5 to 10 percent of breast cancers are related to genetic changes present at birth.

Some red flags that may indicate you are in that 5 to 10 percent:

  • Multiple generations with breast cancer on the same side of the family
  • Multiple people in a generation with breast cancer
  • Younger age than usual at diagnosis (under 50 when diagnosed)
  • Other specific cancers in the family such as ovarian, kidney, pancreatic, or men with breast cancer
  • Ashkenazi Jewish ethnic background

Trained genetic counselors can assess your family history for these risk factors and discuss them with you. Spectrum Health’s clinical genetics specialists can provide information about your risk of a hereditary predisposition to cancer in the family.

They also discuss testing options and help patients decide what is best for them and their family.

Not all women with breast cancer will be “high risk” or even need to have testing performed.

If your history suggests it’s more likely you’re among the 90 percent of women who do not have hereditary cancer, genetics specialists still discuss cancer risks to other women in the family based on family history.

Most people think the only genes they need to worry about are BRCA1 and BRCA2.

While these two are major players in hereditary breast cancer, there are other genes that increase cancer risk.

“With the rapid advances in genetic research and technology, knowledge about genes that cause cancer and other health concerns is constantly growing,” Dr. Bupp said.

The good news is multi-gene panels can provide information beyond BRCA. A family history can also help identify the best person to test so results are the most informative.

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