October 10, 2019
EMPOWERING WOMEN THROUGH GENETIC TESTING FOR BREAST CANCER
ThedaCare Genetic Counselor Explains the Process
APPLETON, Wis. – In the past five years, better access to and understanding of genetic testing for breast cancer has helped to empower women to learn more about the process.
“Celebrities can bring much needed attention to important health topics such as breast cancer,” said Bobbi McGivern, genetic counselor at the ThedaCare Regional Cancer Center in Appleton. “For example, Angelina Jolie had a huge impact on breast cancer testing and treatment awareness. Improvements have been seen in the industry since then.”
In 2013, Jolie publicly disclosed that she had a preventive double mastectomy, removal of breasts, after DNA testing revealed she had a defect in her BRCA, abbreviation for BReast CAncer, gene, putting her at a high risk of developing breast and ovarian cancers. The actress says her family history, losing her mother, grandmother and aunt to breast cancer, prompted her to do so. As a result, there was an initial uptick (64%) in genetic testing nationwide according to one study. Researchers said the study suggests the celebrity endorsement seemingly raised awareness of genetic testing for breast cancer mutations, but it also accelerated over-testing, especially in low-risk groups.
“An individualized approach is key,” McGivern said. “We let women choose what’s right for them. We test and then treat our patients based on their family history, needs and personal decisions. The goal is to catch the cancer early and improve a patient’s chance to beat it.”
A concern about family history is the prevailing reason many people seek genetic testing. ThedaCare offers an online Breast Cancer Risk Assessment where women can calculate their 5-year & lifetime risk of breast cancer.
“This is a way for a person to get more information about their personal risk and to see if they should consider genetic counseling,” McGivern said. “It’s a good way to begin the process of understanding the best approach for each person.”
A physician’s referral to Genetic Counseling at the ThedaCare Regional Cancer Center enables a person to learn more about their cancer risks. If genetic testing is desired, a DNA sample of saliva is usually taken on the same day as the initial appointment. Results are ready in one to three weeks and are discussed by phone or as part of a follow-up appointment.
When it comes to testing positive for a BRCA1 and BRCA2 mutation, McGivern said women should keep three factors in mind.
- Risk doesn’t mean cancer is inevitable. “Your personal and family history and genetic testing cannot predict whether you’ll get cancer, what kind it will be, or when you’ll get it. These only indicate how high your risk is of developing certain cancers,” said McGivern. All women have the BRCA1 and BRCA2 gene. It is women who have a defect in it, inherited mutations in BRCA1 or BRCA2, who are at a greater risk for developing breast cancer.
- Mastectomy may not be mandatory. At times, removal of ovaries is recommended. Detection of a BRCA1/2 gene defect does not automatically lead to a double mastectomy. Patients have treatment options. They might take a more watch and see approach, deciding to have more frequent and thorough mammograms, undergoing 3-D mammography or breast-MRI screening to detect breast cancer in the early stages. However, BRCA1 or BRCA2 also puts women at high risk of ovarian cancer. With “silent” symptoms and inadequate ovarian cancer screening, oncology specialists may suggest women have an oophorectomy, when ovaries are removed.
- Testing outcomes will not interfere with access to insurance and jobs. ThedaCare specialists want to remind women that a law protects Americans from discrimination by health insurance companies and employers. Also, employers are prohibited from using genetic information in the decision-making process regarding hiring, firing, and promotions.
McGivern also notes the cost of genetic testing has dropped significantly. For almost two decades, this testing was unattainable for most people due to costs, which ranged from $4,000 to $5,000 per sample. Then, a U.S. Supreme Court ruling in 2013 invalidated a patent on the BRCA1 and BRCA2 genes, making those genes accessible for research and to other laboratories interested in testing. With a doctor’s recommendation, many insurance companies cover the cost, which is a fraction of what it was decades ago.
McGivern recommends women consult with a genetic counselor and use a reputable genetic testing company to take samples and interpret results accurately. She cites the National Society of Genetic Counselors and the Wisconsin Genetic Counselors Association as good resources for more information on what to look for in a genetic counselor and testing site.
“ThedaCare has two certified genetic counselors and two nurse practitioners specializing in cancer genetics, in addition to other cancer specialists,” said McGivern. “Our experienced team reviews, interprets and discusses results and options for and with our patients.”
ThedaCare is committed to providing the best care possible for patients. The Commission on Cancer (CoC), a quality program of the American College of Surgeons (ACS), has granted three-year accreditation to the cancer program at ThedaCare. As part of the accreditation, we provide education to the community. In order to receive feedback, we ask readers to take part in a short survey regarding the material. If you are willing to respond, please click here.
For more than 110 years, ThedaCare® has been committed to improving the health of the communities it serves in Northeast and Central Wisconsin. The organization delivers care to a community of more than 600,000 residents in 14 counties and employs more than 7,000 healthcare professionals. ThedaCare has 180 locations including seven hospitals located in Appleton, Neenah, Berlin, New London, Shawano, Waupaca and Wild Rose. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving our specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a not-for-profit healthcare organization with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs as well as a foundation dedicated to community service.