Is genetic testing right for you in determining cancer risk?

should i get genetic testing to determine my risk for breast cancer?Medical advances have now allowed us to identify whether patients with certain inherited gene mutations have an increased risk of breast cancer.

Awareness is growing among patients that there are genes related to breast cancer and steps they can take to reduce future risk – but that doesn’t necessarily mean we should all get tested.

Here are some things to consider when deciding whether testing is appropriate for you:

Genetic testing will only provide insight into one area of risk.

You might still be high risk, even if the test shows no gene mutation. Maybe you have dense breasts, maybe you’ve never had kids, maybe you smoke, or you drink alcohol daily. Genetic abnormalities are associated with about 10 percent of cancer cases. That means no matter your test result, if you have factors that place you at higher risk, it is still important to have regular screenings.

If you were tested 5 years ago or more, you may consider retesting.

Back then, tests were only looking for mutations in BRCA 1 and 2. Now, tests routinely look at more than 25 genes that have a connection to increased risk for cancer development.

Make sure testing is appropriate for you.

Testing is most appropriate for those with a family history across multiple generations. Some special populations, such as Ashkenazi Jews, also have a higher tendency toward mutation and would be good candidates for testing.

Genetic testing isn’t just for women.

Gene mutations don’t discriminate and men get breast cancer as well. Testing, however, is not recommended on minors since the mutations inform lifetime cancer risk and children are too young to consider potential interventions.

You’ll want someone with expertise to help with the results.

There are interventions that may reduce the risk of cancer, from more frequently screenings to medication and surgery. Your primary care physician may be a good place to start the conversation, but often a specialist in breast cancer risk is best equipped to partner with patients to help them identify the next steps that are right for them. TMC offers a High-Risk Breast Clinic . Please call 324-2778 for more information.

Dr. Michele Boyce Ley, a board-certified breast oncology surgeon, serves as medical director of TMC’s Breast Health Program. She is accepting new patients and is located at 2625 N. Craycroft Road.

Thinking pink for October and assessing your breast cancer risk

BDP36545October is recognized as Breast Cancer Awareness month, and with so much information readily available under the “pink cloud,” we agree with you that sometimes it all can be overwhelming. So your grandma and your aunt had breast cancer – but your mom didn’t. Are you considered high risk or not? What is the magic age for a mammogram these days – is it still 40? What’s this I hear about starting at age 35? And with all the attention about Angelina Jolie’s recent double mastectomy, is that really the only way to ensure that you never fall victim to this devastating disease? With an overload of information available at your fingertips about breast cancer, what’s the best way to dissect it all?

We sat down with TMC One’s new breast oncology surgeon Dr. Michele Boyce Ley. She’s a board-certified breast cancer surgeon and medical director of TMC’s Breast Health Program. Dr. Boyce Ley brings high-level, compassionate specialty care to TMC’s well established and respected program. We asked her to break down the most important things you should know about breast cancer and we’re going to share her thoughts in a new post each week throughout the month of October.

First up: that high-risk question.

As women, we are all at risk of getting breast cancer. Yes, men are also at risk. But simply being a woman is the number one risk factor. Others include:

∙ getting older
∙ family history
∙ not having children or having children after age 35
∙ receiving hormone replacement therapy
∙ obesity
∙ lack of exercise
∙ more than four alcoholic drinks a week

Let’s focus on that family history for a bit. Dr. Boyce Ley explains the key here is if multiple people from multiple generations in your family have been diagnosed, then you’re considered high-risk. “If your aunt had breast cancer when she was 65, for example, it’s probably not as important as if your mom had breast cancer at age 45,” she said.

Additionally, there are some easy-to-use scoring methods online to help you figure out if you’re high-risk or not. Dr. Boyce Ley is a fan of the bright pink website that offers a user-friendly tool. The National Cancer Institute also offers an online assessment. Still not sure? It’s best to get established with a breast specialist to assess your risk and what to do about it. A breast specialist can also help you figure out your breast density which oftentimes can be another risk factor.

Genetic testing is also an option, but proceed with caution. It’s not for everybody, and there are lots of caveats to it. Dr. Boyce Ley says it really needs to be done by a breast health specialist. Testing used to be limited to just testing for the BRCA 1 and 2 genes. Now there are numerous companies which offer genetic testing for up to 25 different markers. Certainly good information to have, but oftentimes it turns into a case of “We have this info. Now what do we do with it?”

While these mutations have been identified, it takes a highly trained team of clinicians to know how to interpret the results. Genetic testing can make a big difference in the treatment planning but it’s not a one-size-fits-all approach. “The testing can be helpful, but it’s not helpful in the same way for every person,” said Dr. Boyce Ley.

“I always tell my patients who want to pursue genetic testing this: Let’s think this through. If you get the testing done, and you get these results, what are you going to do about it? Your motivation might be to protect yourself or simply to help your children figure out their risk.”

Dr. Boyce Ley warns, however, that testing can have implications for an entire family. “Sometimes there is guilt associated with it if people realize they have passed this gene on to their kids. This isn’t like getting a blood test and finding out you have high cholesterol. It’s a bit more complex than that,” she said. That’s why it’s important to sit down and talk with an expert. Insurance coverage of genetic testing has gotten measurably better with the exception of Medicare, which is more restrictive in covering the cost.

Bottom line: Have a plan before you get genetic testing done.

Doctors continue to develop a better understanding about what characteristics constitute a high-risk patient, and there are an assortment of new drug therapies in the pipeline that work to reduce a patient’s risk. “Just because you’re identified as high-risk doesn’t necessarily mean you need an invasive procedure,” Dr. Boyce Ley said.

Something super simple you can do that isn’t talked about much? Exercise and manage your weight. “It’s been shown over and over again that maintaining a healthy weight and exercising more than four times a week reduces the risk of breast cancer. Those are things you don’t need to see a doctor for. They’re not easy, but they’re free!” she said.

Dr. Boyce Ley is accepting new patients!
She is located at TMC One, 2424 N. Wyatt Dr. #100, on the TMC campus.
Call (520) 324-BRST (2778) to make an appointment.


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461