More women should get test for breast, ovarian cancer risk

Kimberly Knapp, a genetics research nurse at Joyce Murtha Breast Care Center in Windber, speaks to a co-worker on Sept. 25, 2017.



More women should be screened for gene mutations that increase their risk of getting breast cancer, ovarian cancer and other cancers, a national group of experts says.

All women who have had cancer of the breast, ovary, Fallopian tubes or peritoneum tissue in the walls of the abdomen should be offered a screening tool to determine their risk of mutation, new U.S. Preventive Services Task Force guidelines say.

In the past, screening for breast cancer susceptibility genes BRCA1 and BRCA2 was recommended for women who developed breast or ovarian cancer before age 50 and others who had certain types of cancer before age 60, genetic counselor Kimberly Knapp said at Joyce Murtha Breast Care Center in Windber.

“You had to meet that criteria in order to have the test,” Knapp said. “They took that away. That’s a pretty big thing because now we don’t have to age discriminate.”

The task force recommendations were published August 20 in the Journal of the American Medical Association. They call for primary care doctors to offer a risk assessment based on family history of cancer. If the assessment tool shows increased risk, then the woman should see a genetic counselor for possible genetic testing.

“The addition of women with prior breast and ovarian cancer is an important step forward,” Drs. Susan Domchek and Mark Robson wrote in a JAMA editorial published with the task force’s new recommendation. Both physicians are with University of Pennsylvania Basser Center for BRCA.

They went on to say that knowing the BRCA status of patients can help surgeons and oncologists decide how to treat the cancer. Women’s regular medical care should include identifying their BRCA risk, the editorial said.

Athough the task force’s recommendation is limited to the BRCA1 and BRCA2 genes, Knapp said many counselors are using tests that detect a panel of gene mutations associated with cancer risk.

But insurance companies will only pay for what is officially recommended, she adds. Windber works with testing companies that screen for up to 47 mutations.

“Insurance companies don’t want to pay for the full panel,” Knapp said. “What we are doing, we only charge for BRCA, but they have been doing the whole panel. It’s the same cost.”

Because it takes longer for Medicare to adopt new guidelines, at least one testing company is waiving its fees for Medicare patients, Knapp said, explaining that Invitae Corp. introduced the policy as part of a study.

“That way they can gather data to prove to Medicare that they need to do this testing,” she said.

If BRCA mutations associated with cancer risk are detected, counselors recommend screening close family members.

The mutations are estimated to occur in from one in 300 to one in 500 women. They account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases, the task force report notes.

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