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Women who are at high risk for breast or ovarian cancer are armed today with new tools to give them more information than ever before. But with that come difficult choices.
Genetic testing, called BRCA analysis, can help women decide if they should consider having their breasts removed — even when they do not have cancer.
Although considered radical by some, the surgeries are gaining acceptance by women and the medical community with advances in genetic testing.
One of the most notable cases in recent years involved actress Angelina Jolie, who in May had a preventive double mastectomy after BRCA testing showed she had an inherited gene mutation.
Jolie’s doctors estimated she had an 87 percent risk of breast cancer and 50 percent risk of ovarian cancer. After the surgery, her chances of developing breast cancer dropped to 5 percent.
Her message to other women was to know their options and seek the advice of experts, especially if they have a history of breast or ovarian cancer.
In the end, the decision is the woman’s.
At Columbus Regional Health’s Breast Center, women have been informed about testing for the BRCA1 and BRCA2 gene test for the past three to four years, but since early this year test kits have been available at the center.
Deana Tuell, a breast health navigator, said the testing is voluntary. Some women want to take the test because they want to know the results. Some do not.
Staff at the Breast Center let the women make the decision because they know it is deeply personal. This year alone, three women who had genetic testing had positive results and are still weighing their options.
“When women come here for their annual screening mammogram, we look at things, we talk to them,” Tuell said.
“We look at their family history; and if it has what we call red flags for genetic breast or ovarian cancer, then we say you might be at risk. If you want us to talk to you about genetic testing, we will.”
Some of the red flags Breast Center staff look for are:
Someone in family diagnosed with breast cancer younger than age 50.
Ovarian cancer in the family.
Two people in the family with the same type of cancer.
A male in the family with breast cancer.
“There’s no one easy answer. We have to take the whole family history into account,” Tuell said.
She added that some breast cancers occur without a known reason. Others, however, are genetically inherited, and testing can shed some light on who is at higher risk.
Women who typically complete the genetic testing do so for their families, Tuell said. They want to pass on information to their daughters or granddaughters.
Others simply do not want to know or say that they put their faith in God to take care of them, Tuell said.
Tuell said she can’t speak for insurance companies, but she’s found some pay for genetic counseling and some do not. She added that women who fall in the high-risk categories are more likely to qualify for insurance payments.
Without insurance, the testing can cost up to $4,000.
The company that CRH works with, Utah-based Myriad, has a program that allows women to have the testing and not be billed until final costs are determined.
If out-of-pocket costs are greater than $375, women have the choice to the have the company finish the testing or cancel the analysis and not charge the patient.
Tuell added that state and federal laws also are in place that women cannot have their insurance rates raised because of the testing, placing them in a higher-risk category.
“I have not seen one single case where women have been discriminated against (because of the testing),” Tuell said.
The test itself is simple, Tuell added. A kit in the Breast Center involves an oral rinse sample.
Results are known in two to three weeks.
WHAT: Testing for the BRCA1 and BRCA2 gene mutations.
RISKS: If test is positive, risk for developing breast cancer is up to 87 percent over a woman’s lifetime.
TEST: An oral rinse sample is sent to a laboratory operated by Utah-based Myriad with results back in two to three weeks.
WHERE: Columbus Regional Hospital Breast Health Center assists patients with the test kit.
COST: Depends on insurance. Frequently paid if the woman is in a high-risk category.
WHAT’S NEXT: Women can discuss with their doctor the next course of action, which can include a preventive mastectomy.
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