PMMC and PMG South offer cancer risk screening, assessment and counseling

June 27, 2013

In an ongoing effort to provide comprehensive care, the Leila J. Eisenstein Breast Center at Providence Medford Medical Center and Providence Medical Group-OB/GYN Health Center, Southern Oregon, are offering hereditary cancer risk screening, assessment and counseling for risk of BRCA 1 and 2 gene mutations.

The genetic basis of hereditary breast and ovarian cancer (HBOC) is an inherited mutation in either the BRCA 1 or 2 genes. An inherited mutation in either of these genes, also known as tumor suppressor genes, greatly increases the probability of cancer. Approximately 7 percent of breast cancer and 11 to 15 percent of ovarian cancer cases are caused by BRCA 1 or 2.
When assessing hereditary cancer risk, a patient’s personal and family history is collected to investigate the risk for HBOC. Once a patient is identified as being at increased risk, genetic testing is available to confirm if the patient is indeed affected by a BRCA 1 or 2 gene mutation.

Individuals with a family history of a “red flag” indicator are at increased risk of HBOC and should have further clinical evaluation by a qualified health care professional to determine the appropriateness of genetic testing. HBOC-associated cancers include breast, ovarian and pancreatic cancer. Breast cancer includes both invasive cancer and ductal carcinoma in situ. Ovarian cancer includes epithelial ovarian cancer, fallopian tube cancer and primary peritoneal cancer. Red flags are based on medical society guidelines: 

  • Breast cancer diagnosed at age 50 or younger
  • Ovarian cancer at any age
  • Two primary breast cancers
  • Male breast cancer
  • Triple negative breast cancer
  • Pancreatic cancer with a breast or ovarian cancer
  • Ashkenazi Jewish ancestry with an HBOC-associated cancer
  • Two or more relatives with breast cancer, one under age 50
  • Three or more relatives with breast cancer at any age
  • A previously identified BRCA mutation in the family

In addition to screening for BRACA 1 and 2 genes, PMG-South OB/GYN Health Center also screens for Lynch-associated cancers, including primarily colon, endometrial, and ovarian but also gastric, ureter/renal pelvis, biliary tract, small bowel, pancreas, brain and sebaceous adenomas.

Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is the most common cause of the hereditary colon cancer syndromes and is believed to account for 3 to 5 percent of all colorectal cancers. Finding patients at risk for Lynch syndrome and following up with them is a critical step.

Red flags in a patient's personal or family history may indicate an increased risk for Lynch syndrome and aid in the identification of candidates for testing. Personal history red flags:

  • Colorectal or endometrial cancer before age 50
  • Colorectal cancer with MSI high histology before age 60:
  1. Mucinous
  2. Signet ring
  3. Tumor infiltrating lymphocytes
  4. Crohn's-like lymphocytic reaction histology
  5. Medullary growth pattern
  • Abnormal microsatellite instability (MSI) or immunohistorychemistry (IHC) tumor test result (colorectal/endometrial) 
  • Two or more Lynch syndrome cancers at any age
  • Lynch syndrome cancer with one or more relatives with a Lynch syndrome cancer
  • A previously identified Lynch syndrome mutation in the family
  • Family history red flags:
    1. Two or more relatives with a Lynch syndrome cancer or one before age of 50
    2. Three or more relatives with a Lynch syndrome cancer at any age
    3. A previously identified Lynch syndrome mutation in the family

Identifying these high risk patients can be beneficial in terms of accurately assessing the risk of cancer while providing appropriate medical options to reduce cancer risk. A careful review of the family history is an essential first step in identifying high risk patients and families.

Cancer risk assessment and consultation takes place during a pre-counseling session for any patient that meets “red- flag” criteria for inherited gene mutations. During this appointment a more comprehensive family history is assessed, a discussion on how genetics play a role in cancer, breast cancer risk modeling, and evaluating whether an individual may be at an increased risk of developing cancer.

If the family history is significant and applicable, the availability of genetic testing for hereditary cancer will be presented. Should the patient opt to have genetic testing an appointment will be made for post-test counseling and follow-up with PMG-OB/GYN Health Center’s Nancy Hagloch, M.D. A copy of the results and appropriate medical management guidelines will be sent to the patient’s primary care provider for follow-up care. Dr. Hagloch is also available to help manage this portion of the patient’s care.

For more information contact the Leila J. Eisenstein Breast Center at Providence at 541-732-6100, or PMG-OB/GYN Health Center at 541-732-7460 or visit For an additional resource visit