Issue link: https://read.dmtmag.com/i/179241
Who Should get a BRCA Test? Only five to 10 percent of all breast cancers are linked to genetics, according to the Susan G. Komen Foundation, and not all forms of hereditary breast cancer are related to BRCA gene mutations. However, according to the National Cancer Institute, women with mutated forms of BRCA1 or BRCA2 are five times more likely to develop breast cancer than women with nonmutated forms of the genes. Besides the cost, the psychological and medical consequences for a woman who learns her genetic risk for breast cancer can be very complex, so genetic counselors at the UW Breast Center are careful to refer only women who truly should be tested, and they then stay in close contact with women who test positively for BRCA mutations. "We don't want them to get tested inappropriately," says Wilke. "We run statistics and we have national guidelines to know if you meet the criteria." Some of those criteria include a pronounced family history of breast cancer in first-degree relatives. These include a woman's mother, sisters and daughter. A grandmother's breast cancer is also considered, though it's not as strong of a risk factor. The age of the relatives who developed breast cancer is also important. The average age for a woman in the U.S. to enter menopause is 51. Relatives diagnosed with breast cancer before menopause, often in the 40s, indicate a higher chance that the cancer is genetic. Visit BRAVAmagazine.com to learn more about your risk factors for breast cancer. 54 brava magazine | OCTOBER 2013 Some women ultimately decide against taking the BRCA test after talking with genetic counselors. "There are people who don't want to change their natural life pathway," Barroilhet says. "They don't want to be guided by fear." While she says she respects and understands this perspective, Barroilhet ultimately hopes patients will view the test as valuable for making informed choices for the future. "People are empowered by knowledge. It can be traumatic but helpful for patients to make good decisions," Barroilhet says. "It's hard to encourage people to not be defined by this. It shouldn't change who you are." BCRA and the bigger picture Mary Grundahl's mother waged several battles against cancer over many years, first with breast cancer, then lung cancer and finally, brain cancer. So when Grundahl's first mammogram, at age 41, turned up an irregularity, she understood what she might be in for. When Grundahl returned to the clinic for a follow-up six months later, additional growths had emerged and she was officially diagnosed with breast cancer. Her treatment plan was difficult, but clear. In May, Grundahl had a single mastectomy at UW Hospital. She subsequently underwent reconstruction in the summer 2013, and her plastic surgeon anticipates she'll "be looking good by New Year's." Grundahl is part of a growing number of women who receive a breast cancer diagnosis to also receive a BRCA test. Yet for those with nongenetic breast cancer or with genetic breast cancer unrelated to BRCA mutations, a negative BRCA test result isn't always a complete relief. Before taking the BRCA test, Grundahl was hoping to have a contralateral mastectomy, meaning she would have her healthy breast removed preventively along with the diseased one. However, Grundahl tested negative for a BRCA mutation, and the result meant her insurance wouldn't cover the additional procedure. "If insurance would have covered this, I would have had both removed," she says. "I'm not a control freak, but it would have been nice to have the option."