Network News - Winter/Spring 2010 - Canadian Breast Cancer ...

• Women who test positive for
the BRCA2 mutation also have a
50-85% lifetime chance of getting
breast cancer and a 10-20% lifetime
risk of ovarian cancer
• Those with the BRCA1 or BRCA2
mutation have a 50% chance of
passing the mutation on to each of
their children
• Both men and women
can have a BRCA1 or
BRCA2 mutation, and
these mutations can be
inherited from one’s
mother or father
• BRCA1 and BRCA2
mutations also
increase prostate
cancer risks among
men, and in particular
mutations in the
BRCA2 gene also
increase the risks for
pancreatic cancer,
melanoma, and male
breast cancer
• BRCA mutations occur
in individuals of all
ethnic backgrounds,
but are more common
in certain populations. About 1 in
50 Ashkenazi Jews has a BRCA1
or BRCA2 mutation that increases
the risks for breast, ovarian and
related cancers. French Canadians
of certain ancestry may be at
increased risk. There are common
BRCA mutations in the Icelandic
and Dutch populations
• Although they are at increased risk,
not all people with BRCA1 or BRCA2
mutations will develop cancer
According to the genetic counsellors,
people are often unaware that women
with inherited ovarian cancer are at
increased risk for breast cancer while
those with inherited breast cancer are
at higher risk for ovarian cancer.
While the statistics can be daunting,
Armel believes that genetic counsellors
can be of great assistance as “tour guides
that lead people down a path and help
them decide what is right for them.”
There is an education component, which
involves helping the patient understand
genetic testing and reaching a decision
about whether or not to be tested.
Genetic counselling can also encompass
trying to sort out inconclusive test
results, or helping a person come to
terms with a positive result and then
developing a plan of action.
What can a woman do if she tests
positive for a BRCA mutation and is at
increased risk of developing cancer?
Susan Armel (Left) and Rochelle Demsky (Right)
For ovarian cancer: Regular
monitoring (pelvic or transvaginal
ultrasound and a CA125 blood test);
oral contraceptives (birth control pill);
prophylactic oophorectomy (surgical
removal of ovaries and fallopian
tubes); and hysterectomy (removal of
the uterus).
For breast cancer: Screening (breast
self-exams, clinical breast exams,
mammograms and MRIs); medications
such as Tamoxifen; prophylactic
oophorectomy (surgical removal
of ovaries and fallopian tubes); or
prophylactic mastectomy (surgical
removal of the breasts).
Genetic counselling and testing are
concentrated in major Canadian centres.
Some provinces and territories access
these services through other provinces.
Patients from smaller communities
and rural or remote regions may avoid
significant travel by accessing genetic
counsellors via Telehealth Ontario. If a
person decides to proceed with testing
after counselling, a blood sample can be
taken by local health professionals and
sent in for analysis.
Some of the newer trends in genetic
counselling involve group sessions for
the teaching component, followed by
individual sessions with each patient.
Depending on the patient’s wishes,
some centres will provide test results
by phone, followed by
an in-person meeting
with their counsellor to
explore options.
Armel and Demsky
can envision the day
when genetic testing
is routinely used to
help determine a
course of treatment for
those diagnosed with
hereditary breast or
ovarian cancer.
In the meantime,
while acknowledging
the challenges of the
job, they say genetic
counselling offers
many rewards. Says
Armel: “Although testing isn’t right for
everybody, we feel that we are helping
prevent cancer and I think our patients
see it that way too.”
For more information, please visit:
Hereditary Breast and Ovarian
Cancer Foundation
www.hboc.ca
Hereditary Breast and Ovarian
Cancer Society
www.hbocsociety.org
FORCE: Facing Our Risk of Cancer
Empowered
www.facingourrisk.org
Willow Breast Cancer Support
Canada
Visit www.willow.org or call
1-888-778-3100
To find a genetic counsellor, contact
your family physician as a first point
of reference; also refer to the Canadian
Association of Genetic Counsellors at
www.cagc-accg.ca . •
20 Network News Winter/Spring 2010