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Know Your Risk: The Facts on Genetic Testing for Breast Cancer

April 22, 2019

At a recent breast cancer workshop at the Schertz Civic Center in San Antonio, Dr. Sangeetha Kolluri of Texas Breast Specialists–San Antonio Northeast and Westover Hills held an interactive discussion with patients, survivors, and their families. During the discussion, she shared important facts and debunked common myths related to genetic testing for breast cancer. Dr. Kolluri answers some of the key topics discussed.

Dr. Sangeetha Kolluri speaks to attendees at a workshop on the importance of breast cancer awareness and genetic testing in San Antonio.

Dr. Sangeetha Kolluri speaks to attendees at a workshop on the importance of breast cancer awareness and genetic testing in San Antonio.

What are the most important considerations for patients, regarding surgery – mastectomies – when genetic testing results show the patient has the BRCA gene mutation?

First, it’s important for patients to have a detailed understanding of their future risk of not only developing a first-time breast cancer, but also a second breast cancer in the opposite breast. Not all hereditary mutations are created equally and some increase the risk of breast cancer more than others.

Patients should also have a clear understanding of what a mastectomy is, what it does to the body, how it affects breast sensation (and possibly breast sexuality), and potential complications of surgery. We also discuss reconstructive options like implants, as well as the option of “going flat.” At the end of the day, all the considerations for this type of surgery must fundamentally be centered around the patient’s desires and goals for their personal treatment outcome.

Should every patient with the BRCA gene mutation get a mastectomy? Why not?

This is a frequent topic of debate at our breast surgery conferences. I often utilize a customized risk calculator which provides a future risk calculation based on the patient’s known mutation type, current age, previous surgeries, and cancer history. This calculator provides the future risk data, shows at which future point the patient’s risk will escalate, and why we recommend timing prophylactic surgery at a certain age for patients. If a patient is coming to us at 35, her future risk of breast cancer with a BRCA1 mutation will be quite high. On the other hand, if she is coming to us at 70 with the same mutation but no history of any cancer, her calculated future risk will be lower. If she already has other major medical problems, we would likely consider close observation instead of a larger surgery.

In addition to, or instead of surgery, what other options are available to patients with genetic risk for cancer?

I see many patients who are high risk for breast cancer, but don’t know how elevated their risk is. Frequently, these patients think “waiting for it to happen” or proactive surgery to remove their breasts are their only options. To ease these concerns, I use the Texas Oncology’s Genetic Risk Evaluation and Testing Program’s Hughes Risk application to calculate the 5-year, 10-year, and lifetime risk of all our breast cancer patients. The patients with a greater than 20 percent lifetime risk are put on our high-risk protocol, which typically includes a yearly screening MRI, yearly mammogram, and breast exams every six months depending on age and other factors. Some patients are also candidates for a type of medication that can potentially reduce their future risk of breast cancer by up to 50 percent. If a patient meets the criteria for genetic testing based on family history, we recommend that testing as well.

What’s the difference between genetic risk and family history? What should everyone know about the potential to inherit cancer risk?

We see many patients with a family history of cancer, but only a few will be found to have a hereditary mutation on our current genetic testing panels. The patients with strong family history, but whose genetic testing was negative, may still be high risk, and we monitor them with our high-risk protocol. It’s important to remember that we can inherit risk for breast cancer from the paternal family just as easily from the maternal family. The best thing a patient can do for him/herself is to know the full family history of cancer on both sides, including other cancers such as ovarian, prostate, colon, melanoma, and leukemia.

For upcoming webinars visit www.TexasOncologyFoundation.org.