How do I find a genetic counselor?
To be seen by a genetic counselor at Penn Medicine, contact the Cancer Risk Evaluation Center at 215-349-9093. You can also search the National Society of Genetic Counselors’ Find a Genetic Counselor tool at nsgc.org or contact your local cancer center. Genetic counselors who perform BRCA testing are often a part of the breast group of academic medical centers or cancer centers.
Who should consider genetic counseling?
Consider genetic risk evaluation if you or a family member has had*:
- Breast cancer at age 50 or younger
- Triple negative breast cancer at any age
- Ovarian or fallopian tube cancer at any age
- More than one breast cancer diagnosis
- Male breast cancer
- Breast, ovarian, or pancreatic cancer and are of Ashkenazi Jewish ancestry
- A known mutation in a cancer risk gene
- Breast, ovarian, pancreatic, or high grade prostate cancer diagnosed in multiple individuals on the same side of the family
* A genetics specialist can help to determine if your personal and/or family history meets these or other criteria
Does insurance cover BRCA testing?
In the Unites States, BRCA testing is usually covered by insurance if the patient meets certain criteria. Many insurance companies have developed guidelines indicating what criteria must be met in order for them to cover BRCA testing. These criteria typically involve a combination of family, and sometimes personal history of cancer. Insurance coverage and criteria varies by insurance plan, and genetic counselors are excellent at determining whether insurance is likely to cover the testing.
Some companies do not cover appropriate testing. For example, Medicare covers BRCA testing in many instances but only when the individual has had a cancer. Someone with a known mutation in the family with no personal history of cancer is not covered. Medicaid coverage typically varies by state.
What are the cancer risks for people with mutations in BRCA1 and BRCA2?
A positive BRCA1 or BRCA2 test result means that a person has an inherited mutation in either gene and is at increased risk for certain cancers, including breast, ovarian, prostate, and pancreatic cancers. Women who carry mutations in BRCA1 or BRCA2 have up to a 75% risk of developing breast cancer and up to a 50% risk of developing ovarian cancer. Men who carry BRCA gene mutations also have increased cancer risks, including male breast and prostate cancer.
How can I reduce or manage my cancer risk?
There are things that can be done to address and reduce your cancer risk. A personalized cancer risk management program can be developed for individuals known to be at increased cancer risk due to a mutation in BRCA1 or BRCA2. You and your doctors will ultimately decide what plan makes the most sense for you. Cancer risk management generally includes the following categories:
- Intensive screening to increase the chances of early detection, should cancer develop.
- Prophylactic or risk reducing surgical removal of ovaries and consideration of prophylactic removal of the breasts.
- Chemoprevention, which is taking a medicine shown to lower the chances of developing cancer.
How are BRCA-related cancers treated?
BRCA-related cancers are treated based on the clinical characteristics of each cancer. For example, in early stage breast cancer, tumor size, involvement of lymph nodes, and results from testing the tumor for specific molecular markers (such as estrogen and progesterone receptors and Her2/neu) can influence treatment recommendations.
Where can I find a support group or peer-to-peer support?
Individuals and families facing hereditary cancer and cancer risk have unique informational and support needs. There are many organizations that provide information and support programming, including support groups and peer-to-peer matching, for specific types of cancers or diagnoses.