Breast Cancer: Genetic Testing
Cancer is a disease of the genes. Most cancers develop as a result of genetic damage or a change (mutation) that happens sometime during a person's lifetime. These are called sporadic cancers. This means they occur by chance. These types of mutations only affect the cells that grow from the original mutated cell. Cancers that result from DNA damage that is passed on are called hereditary cancers. These cancers tend to run in families. They cause hereditary cancer syndromes. But overall only about 5% to 10% of all breast cancers are hereditary. If you are believed to be at risk for a hereditary cancer syndrome, genetic testing can be helpful. It can be used to look for the gene changes linked to these syndromes.
Cancer and genes
The risk of developing cancer is higher in people who are born with certain genetic changes (mutations) that are passed on from their parents and found in every cell in their body. These changes are in areas of the DNA that affect cell division, cell death, and the repair of damaged DNA.
Genes are pieces of DNA. They determine how your body looks, grows, and works. But environmental factors influence the true outcome. For example, a woman might have the genetic potential to be 6 feet tall. But if she has poor nutrition as a child, she may not reach that potential. Or a woman may have a genetic risk of developing breast cancer. But whether she develops it may be influenced by environmental exposures she has during her lifetime.
Genes come in pairs. One pair is passed down (inherited) from your mother and the other pair from your father. Genetic risks and outcomes can come from either parent.
A number of genetic problems or defects can result in an increased risk for breast cancer. The most common defects are found on genes named BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2). A woman who has inherited a harmful mutation in BRCA1 or BRCA2 is at higher risk of developing breast cancer (and some other types of cancer) than a woman who does not have such a mutation. Still, not all women with BRCA 1 or 2 mutations develop breast cancer. And not all women with breast cancer have these mutations. Environmental factors can influence a person’s cancer risk, just as they influence things such as height.
Common cancer syndromes that can be identified with genetic testing
These are some of the more common gene mutations that are linked to cancer syndromes and can be found with genetic testing:
APC genemutations. These can cause familial adenomatous polyposis (FAP). This syndrome causes colon polyps, colon and small intestine cancer, and cancers of the stomach, bone, skin, brain, and other tissues.
BRCA 1 and BRCA 2 gene mutations. These are linked to hereditary breast and ovarian cancer syndrome. These mutations can put a person at an increased risk for breast (in both men and women), ovarian, pancreatic, and prostate cancer.
MSH2, MLH1, MSH6, PMS2, and PMS2 gene changes. These can cause Lynch Syndrome (hereditary nonpolyposis colorectal cancer). This is linked to many different kinds of cancer, including those that start in the colon, rectum, endometrium, ovary, kidney, pancreas, small intestine, liver and biliary tract, stomach, brain, and breast.
PTEN gene changes. These cause Cowden syndrome. This is linked to breast, thyroid, endometrium, ovarian, and other cancers.
TP53 and CHEK2 gene mutations. These cause Li-Fraumeni syndrome. They are also linked to an increased risk of many cancer types, including breast cancer, sarcoma, leukemia, and brain tumors.
There are other rare gene mutations that can cause inherited breast cancer, too.
Deciding on genetic testing for cancer
Genetic testing for cancer should strongly be considered in people with all of the following:
A personal or family history that suggests a hereditary cancer syndrome is present, such as:
Cancers have been found at unusually young ages
Several close relatives who have had the same kind of cancer
One person has had multiple types of cancer
Cancer has been diagnosed in both organs when organs are found in pairs, such as both breasts or both kidneys
There's evidence of other birth defects that are linked to certain cancer syndromes
Other family members have been tested and have genetic mutations that are linked to cancer
A genetic test is available and has been proven to be accurate
The results of testing can help the person make decisions about medical care
It's strongly recommended that anyone considering genetic testing first talk to a professional about it. It's important to understand the limitations of genetic testing and how the test results might be used before getting tested. You also need to discuss the costs and whether your health insurance will help pay for testing.
If you are considering genetic testing for cancer risks, you face many complex issues. If you test positive, you may face difficult decisions about treatments to prevent cancer. You may have increased fear and anxiety about developing cancer. You may have concerns about losing your health insurance coverage. If you test negative, you may also face difficult challenges, such as survivor guilt, if other family members have tested positive.
However, if you are anxious or considering treatments such as preventive surgery based on your family history, having the results may be very helpful. Because of these issues, you should seek genetic counseling before, during, and after any genetic testing. Remember, genetic testing cannot tell you everything about inherited cancers. A positive result does not always mean you will develop cancer, in most cases other factors are involved. In the same way, a negative result does not mean you won't get cancer. Genetic counselors can talk to you about what a particular test will or will not tell you, and can help you decide whether to get tested.
How is genetic testing done?
In most cases, a blood sample is needed to do genetic testing, but sometimes saliva, skin cells, or cells swabbed from the inside of the cheek can be used. The sample is sent to a lab where the actual testing is done. It usually takes a few weeks to get the results.
You will meet with the genetic counselor to go over the results and figure out what they mean for you and your family.