Leila J. Eisenstein Breast Center at Providence offers testing for BRCA1, BRCA2

May 24, 2013

Actress Angelina Jolie made headlines — and fueled a national discussion — in early May with her announcement that she had a double-mastectomy to prevent breast cancer because she carried a gene associated with the disease. The genetic test that convinced Jolie she needed the operation has been available in Medford since January at the Leila J. Eisenstein Breast Center at Providence Medford Medical Center.


Jolie's test showed that she carried a gene mutation, known as BRCA1 or BRCA2, which indicates an increased chance of developing hereditary breast or ovarian cancer. Jolie's actions have drawn attention to the preventive measures those who carry the gene can take.


"This is something you can pass to your children," said Kate Newgard, oncology nurse navigator at the Leila J. Eisenstein Breast Center at Providence. She notes that both mothers and fathers can be carriers for the gene.


In January, the Medford breast center began offering free hereditary breast and ovarian cancer risk assessments, which include a questionnaire and a comprehensive look at family medical history, and counseling about options which includes genetic testing for the BRCA1 and BRCA2 genes as well as Lynch syndrome.


Patients who test positive for either one of the gene mutations potentially face a risk as high as 87 percent of developing breast cancer, according to Newgard. The chance of developing ovarian cancer is potentially upward of 47 percent.


"What we tell women is that if they test positive for a BRCA 1 or 2 mutation they carry a lifetime risk for the development of breast or ovarian cancer," said Newgard. "That's not today -- the increased risk is spread out over their lifetime.”


When the genetic tests first became available, they were used primarily for people who had already had cancer. Local people who wanted to be tested often were referred to genetic counselors in Eugene or Portland, which prompted Providence Medford Medical Center to start its own program.


"There was a real need in the community because we didn't have anyone who was doing the genetic counseling," said Dr. Nancy Hagloch, from the Providence Medical Group OB/GYN Health Center. Hagloch is trained to perform the counseling.


Before testing, patients fill out a questionnaire examining family history and other risk factors to determine whether they meet the “red flags” for the BRCA 1or 2 mutation, followed by consultation. People interested in the test should know which of their relatives have had cancer and at what ages those relatives were diagnosed. Questionnaires ask about first- and second-degree family members, and it is important for patients to understand the difference. First-degree family members include mothers, fathers, sisters, brothers and children. Second-degree family members include aunts, uncles, grandparents, nieces and nephews.


"Genes trickle downhill," said Newgard, noting that patients often are concerned about cancer in distant relatives. "It has to be passed from a parent to a child and can be passed again when that child becomes a parent.”


If it is determined that genetic testing would be worthwhile, a blood sample can be drawn the same day. The results take about five weeks, and a follow-up consultation with Hagloch would be scheduled. If the results come back positive, there are three possible levels of preventive care: increased screening and surveillance, drug treatment or — a last resort — surgery such as a mastectomy or hysterectomy.


Newgard says that while the causes of some cancers are understood, many occur sporadically and remain a mystery. Even if a person has a family member who has had cancer, it may not be caused by genetics.


"You really look for patterns," said Newgard. "But when you see those random cancers in families, sometimes it's just random cancers." People who have complicated or multiple types of cancer histories may be referred to other cancer genetic specialists for risk assessment, she noted.  


BRCA 1 and 2 testing legally can be performed at age 18, but it is important to know that the cancer risks associated with BRCA 1 and 2 mutations rarely manifest before an individuls late 20s or 30s. Newgard fears that testing younger patients may cause unnecessary worry and notes that the BRCA 1 and 2 national guidelines really don’t offer any intervention until about age 25. There are no guidelines for testing children and if a parent chooses to have a child tested that takes away the right on if and when an individual may choose to test.


"All of this is meant to help women and empower them, not to scare them," said Newgard. She recommends that women who are concerned they may carry the gene examine their family history and potentially pre-screen themselves using resources online such as brcanow.com