Sheryl Cherico, Dr. Gulshan Harjee, and Patti Dickey will be on 11 Alive’s Atlanta and Company this morning! Tune in at 11:00AM to see us advocate for breast cancer!
A volunteer panel of national experts the US preventive Services Task Force (USPSTF) in 2013 last recommended that genetic testing be recommended for women with a family history of breast , ovarian , tubal and peritoneal cancers That was recently updated to now include women who have in the past been diagnosed and completed treatment for breast, ovarian and tubal cancers who are now determined to be cancer free and those with ancestries with BRCA 1 and BRCA2 such as those of Ashkenazi Jewish descent
If a woman is determined on an initial assessment by her Primary Care doctor to be of high risk she should be referred for genetic counselling and then genetic testing for the mutations of BRA and other types.
Routine genetic testing is not recommended. One must realize that breast cancer though the second most common cancer in women, the genetic type is very rare. Genetic mutations are about 5 to 10% of breast cancers and 15% of ovarian cancers.
If one is found to have a cancer mutation then several steps may need to be taken to reduce one’s chances of getting cancer. Some such possibilities include taking medications or undergoing risk reducing surgeries like the ones that Angelina Jolie chose to have. This information may become important for first degree relatives and daughters. Taking the right steps is absolutely important so that one’s Health Insurance will pay for all the procedures, consultations and medications from start to finish.
There are other deviations from the usual in that there are disparities in the incidence of breast cancer ie certain minority groups have a higher incidence of breast cancer independent of personal or family histories. The Primary care Physician should make those determinations. Despite following the right procedures my own Insurance company took 2.5 years to pay for my testing expenses.
Genetics is a rapidly growing and changing field. Unquestionably, some people are enjoying the new “direct-to-consumer” versions of genetic testing, finding new relatives or learning more about their family history. Examples of direct-to-consumer test include 23andMe and Ancestry.com.
Genetics is the scientific study of heredity and genes. The question today is, where does science end and commercialism begin? Is 23andMe a scientific study? Which is the correct test for men and women who fall in a high-risk category for breast cancer or prostate cancer?
Since breast cancer strikes both the young and the old, it’s important to know that both private insurance and Medicare will usually cover the costs of genetic testing and counseling when recommended by a qualified physician. A very important question is whether the results of genetic testing can be used to deny health insurance coverage or increase insurance premiums? The answer is no; however, it could impact the ability to get Long Term Care or Life Insurance. No health insurance pays for direct-to-consumer tests. If a genetic counselor assesses genetic risk and recommends counseling, she can coordinate with your physician to order testing. In this case, insurance usually pays. It is prudent to be sure the genetic counselor contacts your insurance company to verify payment.
Genetic counselors are highly educated individuals who map your heredity. Through you, they identify each family member, male or female, who had cancer. In the case of breast cancer, they will look specifically for information on any males or females (parents, siblings, aunts, uncles, cousins) with breast cancer history and any males with a history of prostate cancer. Genetic mutations that we already knew were associated with breast cancer have been shown to be the same mutations that cause an increased risk of prostate cancer.
There is one other option for genetic testing and that is the Mayo Clinic GeneGuide. The Mayo Clinic product tests for specific variants (mutations) that are related to specific diseases. Breast Cancer is NOT on of the variants tested. The diseases for which Mayo’s GeneGuides tests can be found on their website mayo.org.
How do I choose between genetic counseling by a professional plus testing and direct-to-consumer testing? Here are some pros and cons.
Genetic Counseling/Testing with a Professional
|Direct-to-Consumer Testing||Mayo Clinic GeneGuide|
|Identifies thousands of mutations, many in the BRCA1 and BRCA2 genes||Direct to Consumer testing identifies only 3 mutations associated with BRCA1 and BRCA2||Test for specific variants (mutations) that are related to specific diseases. Breast cancer is NOT one of the variants tested|
|Expensive, but usually paid by insurance or Medicare||Inexpensive but the entire cost goes to the consumer||Not covered by most insurance|
|In depth counselling regarding the
meaning of the tests
|No counselling||Pre-and post-testing is available, but a personal physician would be the major point of contact|
|Results are safeguarded by general medical privacy (HIPAA) rules||No privacy guarantee at all. Information could be shared||Results are safeguarded by general medical privacy (HIPAA) rules|
|Requires an order from a physician.||No order required.||Healthcare provider determines whether the test is appropriate on an individual basis|
In summary, genetic testing is meant to determine whether an individual has inherited a mutation associated with a specific condition such as breast cancer. Although 23andMe has been approved by the FDA for breast cancer screening, their report only reports on 3 mutations of BRCA1 or BRCA2. The only reliable test to date is via a physician order and genetic counseling. GABCC recommends discussing genetic testing with a physician first. If risk for breast cancer is determined to be high, genetic testing should be ordered. Contacting and making an appointment with a genetic counsellor recommended by your physician would come next. Relying on their expert judgement and a primary care physician or specialist, will provide the best outcome for disease prevention.
There is clearly new data published in The Lancet from the UK clarifying the risk of breast cancer in women who took HRT beyond one year after menopause. Though the risk may appear small, in the Western Countries 6.% of women of average weight will develop breast cancer over 20 years from age 50 years without HRT compared to 8.% taking the Estrogen progesterone combination. Women who are obese are at much greater risk than normal-weight because fat cells produce additional estrogen at menopause. Those who took progesterone only for 10 to 14 days a month had odds of 7.7% while those who took estrogen-only due to having had a hysterectomy had a breast cancer risk of 6.8% Taking HRT should be a personal deduction based on current information. Past studies that encouraged HRT as protection of bone strength is no longer supported as are the data that HRT protect against Heart attacks or strokes. Stopping HRT does not reverse the risk however any decision to discontinue HRT must be discussed with one’s physician. The study from Oxford confidently mentions that 5% of breast cancers could be related to HRT and tend to be of the Estrogen receptor Positive Type (ER ) responding to Tamoxifen type drugs.
What Minorities Need to Know About Current Breast Cancer Screening Guidelines
By Dr. Gulshan S. Harjee, MD
Every April, the American Cancer Society, and other organizations work together to raise awareness around cancer amongst minorities. National Minority Cancer Awareness Week is celebrated this week (April 15.) The Georgia Breast Cancer Coalition supports these efforts and would like to help our minority communities know a little more about breast cancer screening guidelines. A recent research report published in the journal, JAMA Surgery, showcases the current problems with breast cancer screening guidelines for minorities.
Current Breast Cancer Screening Guidelines are Based on Scientific Data from White Women
Researchers like David Chang from the Massachusetts General Hospital’s department of surgery believe that the scientific research process has been neglected in developing breast cancer screening guidelines. Much of the data collected has been from white women, and this bias could lead to delayed detection in minorities.
Minorities are at Higher Risk of Developing Breast Cancer at Earlier Age
The U.S. Preventive Task Force recommends breast cancer screening for women at age 50 with average risk. Researchers worked with the U.S. National Cancer Institute to analyze data from women aged 40 to 75 who were diagnosed with breast cancer between 1973 and 2010.
The data showed that the average age at diagnosis for white women was 59, 56 for black women, 55 for Hispanic women, and 46 for Asian women. They also looked at the % of patients diagnosed before 50 and found 31% were black, 35% were Hispanic, 33% were Asian, and 24% were white. Researchers believe that the data shows that minorities need to start breast cancer screening sooner than 50.
Conclusion and What to Do
These new findings and analysis on breast cancer screening are enlightening for minorities to make better decisions at the right time. Minorities are at a higher risk of developing breast cancer earlier, and as a result, should start testing much earlier than age 50 which is recommended.
Visit the resources below for more information on breast cancer screening.
In a landmark decision, the Federal Drug Administration (FDA) has approved the first ever breast cancer genetic test developed by leading at-home genetics company, 23andMe. People will now have the ability to test themselves at home for genetic risk factors connected to ovarian and breast cancer without their doctor’s permission. The approved at home genetic test will look for three mutations of the BRCA1 and BRCA2 genes.
While the news of an at home BRCA test is exciting, we should take notice of the cautions and stipulations that came with the FDA’s announcement.
The Test is Not a One Size Fits All
While the test does look at 3 mutations, there have been over 1,000 mutations of the BRCA1 and BRCA 2 genes identified so far. On top of that, the mutations tested for in the 23andMe test are not very common and according to the FDA only found in about 2% Ashkenazi Jewish women.
In a press release from 23andMe, they do look at this authorization as an important step in the right direction. Christine Pai, communications manager at 23andMe, told Newsweek that people who carry one of these three mutations have up to an 85% chance of developing breast cancer before 70.
Experts Caution About Using Test For Health Decisions
The FDA stated in their press release that citizens should not use this test to make substantial healthcare decisions. The U.S. Preventive Services Task Force recommended against testing for BRCA in women who do not have a family history of breast or ovarian cancer.
“While the detection of a BRCA mutation on this test does indicate an increased risk, only a small percentage of American carry one of these three mutations, and most BRCA mutations that increase an individual’s risk are not detected by this test.”
Donald St. Pierre – Director of Office of In Vitro Diagnostics and Radiological Health
The CEO of 23andMe, Anne Wojcicki, does echo the concerns of the FDA. She believes it is important to understand that the majority of cancer is not hereditary. The 23andMe test does not look for all the genetic variants of BRCA, and people should continue with recommended cancer screenings.
On behalf of everyone in the GABCC family, we would like to send our deepest condolences to Mr. Ron Johnson on the passing of his dear wife Mrs. Judith Whipple Johnson.
In her honor, we have received so many generous donations. We are so thankful and will work tirelessly to help, assist, and advocate for Breast Cancer Patients and Survivors in Georgia.
A special thanks to:
The Georgia Breast Cancer annual retreat is scheduled for January 20, 2018. We are always excited about this Board requirement so we can plan out all the exciting things Georgia Breast Cancer will be doing for 2018.
This year, the Georgia Breast Cancer plans on working more with patients, and funding medical and diagnostic testing for women and men who have had abnormal mammograms and need additional testing. We will also be working with lymphadema patients, and working towards providing them with the sleeves they so badly need.
In addition to the good work we have planned, we are going to increase our Board presence by adding new Board members, and have our Board visit the community more often. We will also be building new partnerships so we can spread awareness, and help raise funds to assist more patients with transportation, tests, groceries, and whatever else they need to relieve some of the stress they have.
Georgia Breast Cancer will also continue its advocacy this year with a visit to the State Capital. We are working with Pfizer to help facilitate a luncheon, and support various bills that can help breast cancer patients.
Lastly, we will be scheduling more fundraisers this year and are always looking for donations of gift cards, cash and silent auction items. Feel free to contact Jennie Palmer, our Executive Director if you can help.
2018 is going to be GREAT!
Sheryl Cherico, President
The Georgia Breast Cancer Coalition had a great and productive meeting at DeKalb Medical on Monday.
The meeting centered on what GABCC could do to help breast cancer patients at DeKalb Medical. DeKalb Medical expressed that they have 10 women from their October screening that need an ultrasound follow up. GABCC has committed to paying for these 10 ultrasounds. In addition, GABCC is looking into the opportunity to fund a much-needed biopsy for a DeKalb Medical breast cancer patient. GABCC is thrilled to partner with this incredible medical institution to serve Breast Cancer Patients in Georgia.
POST YOUR HEALTHY SELFIES THIS #GIVINGTUESDAY
Share your #HealthySelfie. Follow three simple steps for a chance to win $500 for GABCC!
As the holiday season approaches and it’s time to consider what we have been grateful for in 2017, #GivingTuesday is a great time to start thinking of ways to give back our communities and the causes we care about.
This November 28, join us for #GivingTuesday and help GABCC win $500 for getting supporters to post their #healthyselfie and selecting GABCC charity, should when you win.
You can also learn about six ways to give in addition to the contest.