ó A genetic test to find out if people are more susceptible
to breast cancer is available, but how do you decide whether
to get it? With a lot of thought, cautioned Dr. Nora Hansen,
director of the Lynn Sage Comprehensive Breast Center at
Northwestern Memorial Hospitalís Prentice Womenís
Hospital. She explained what patients should know.
example, no medical standards dictate exactly who should get
the test and when. Taking the test, which can show whether
people have threatening mutations in the BRCA1 and BRCA2
tumor-suppressor genes, can leave patients facing serious
options, like surgery to remove breasts. If the test comes
back positive, Hansen noted, there are organizations that can
help, including Bright Pink. This is an edited version of the
do you explain this test to a patient?
have a long discussion with them. We ask multiple questions.
There are questions related to their own self, in terms of
when was their first period, when did they have their first
child. If theyíre post-menopausal, at what age did they go
through menopause. In order to decide should a patient be
tested for the gene, you really go through a family history,
and so you want to know who in the patientís history, both
the motherís and the fatherís side, had any history of
breast or ovarian cancer.
do you decide whether someone is a good candidate for genetic
A: Say a
patient came in to see me and her mother had breast cancer at
the age of 38 and her motherís two sisters as well, and the
grandmother had breast cancer, too. That would be a sign that
that family has a lot of breast cancer, and theyíre very
young, which would make you think this could be gene-related.
should a patient consider before thinking about the test?
donít just want to send off the blood test and find out the
information. Itís very important that the patient meet with
a genetic counselor who would really develop this family
pedigree and help decide. You want to have some likelihood
that the patient would be positive before you test. If they
have a very low risk of having the gene, itís not worth
testing, but if they have a higher risk, greater than 10
percent, then they would get tested.
testing comes with a lot of implications ó implications for
the patient, for any family members, for the children ó
because it affects everyone. I have a lot of patients that donít
want to know. They say theyíre just not ready to handle the
information. They donít know what theyíre going to do with
the information. And in some ways, if youíre not going to
act on the results, it almost doesnít make sense (to get the
advice on whether to take the test any different for age
ranges, for example, for someone 20 years old or 50?
A: We do
think that most patients who have the gene develop breast
cancer usually at an earlier age. For the genetic testing, youíd
probably want to be tested earlier than later. I wouldnít
recommend testing anyone under 20, because what are you going
to do with that information? A 30-year-old doesnít get any
(recommended) imaging at this point, but if we knew she were
positive for the gene, we would get imaging for her at this
anyone go into a doctorís office and request this test?
A: A lot
of gynecologists order genetic testing, because a lot of
younger women, thatís their doctor. Oftentimes whatíll
happen is, Iíll see a patient who comes in; a gynecologist
ordered the test for her, she came out positive and now she
has no idea what to do. Ideally, it would have been best if
she was seen in the high-risk clinic first, to go through the
implications of the tests. Once you have the results, you have
the results, and thereís no going back in a sense.