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The BRCA gene test can identify inherited gene mutations that leave carriers with elevated cancer risk. But many women are scared to get the test, because they’re afraid to learn they carry a BRCA mutation. Is ignorance bliss?
“It’s a legitimate fear,” acknowledges Breast Surgeon Dr. Kristi Funk. “Even though it’s a simple DNA test through blood or saliva, so it’s not painful, the results can be devastating -- and it forces you to make decisions.”
Depending on the gene variant, carriers have up to an 87 percent greater chance of developing breast cancer and a 45 percent greater chance of ovarian cancer than the general population. BRCA-2 also carries elevated risk for pancreatic, melanoma, and prostate cancers.
“Women say to me, why would I want to know about something over which I have no control, which could possibly kill me?” says Dr. Funk. However, she has an answer for that question: “Knowledge is power, and as cliché as that might sound, you now have the power to do something if you know you have one of these mutations.”
In spite of misconceptions, there’s a lot that BRCA carriers can do to lower their risks. High-risk surveillance via frequent mammograms and MRIs can catch cancers earlier, when they’re more treatable. Just taking birth-control pills can cut ovarian cancer risk in half, while the drug Tamoxifen can help protect against breast cancer.
And some younger women with extensive family histories of cancer may choose removal of their breasts and ovaries. Dr. Funk says the prospect of this kind of surgery can be one reason women don’t want to take the BRCA test. “Women think “I have to take my breasts and ovaries out?’ No! You don’t have to.” The power to make that decision always lies with the woman herself, and in any case this kind of preemptive surgery is often not the best option. “The older you are, the less risk you have, you probably shouldn’t do that.”
ER Physician Dr. Travis Stork asks Dr. Funk who should get the BRCA gene test. She explains that there are different rules of thumb. “The basic easy one is, if you have two relatives with breast cancer under age 50 or ovarian cancer at any age, you are red-flagged for testing.”
Her own guidelines are “Multiple, young, and rare.” Women with multiple cancers (more than three) on one side of the family -- breast, ovarian, melanoma, colon, prostate, pancreas, or stomach. Young meaning a relative under 50 was diagnosed with cancer. And rare? Dr. Funk notes that one man in three gets prostate cancer. But a male relative with breast cancer, or a history of ovarian cancer in the family indicate that a woman should test.