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Breast Cancer Genetics: The Role of Your Family Physician

Posted May 15 2013 3:00am
Timing is everything.  If you've been following along, I was going to end my 3 part commentary on Men's Journal 's June 2013 issue on statin use and cholesterol testing.  However, if you were anywhere near any form of news dissemination, whether traditional newspaper , television, or radio, or glued to your Facebook and/or Twitter accounts, no doubt you heard about Angelina Jolie 's self-penned article published yesterday in the New York Times opinion pages .

In it, she details some of the science & statistics behind her decision to undergo a prophylactic double mastectomy w/reconstruction to minimize her risk for breast cancer based upon Myriad Genetic's $3,000 BRCA1 & BRCA 2 testing for two breast cancer genes that significantly increase one's risk.  It should be interesting to see whether she makes public her decision regarding prophylactic oophorectomy , given her increased risk for ovarian cancer, too, as her genetic testing revealed.

So what does your family physician have to do with all this?  For starters, we should already be familiar w/your family history, which can go a long way towards ascertaining your risk.  Next, we can use any number of risk calculators, such as the Breast Cancer Risk Assessment Tool (commonly known as the Gail model), SeeMyRisk Breast Cancer Calculator , and even Hall's Detailed Breast Cancer Risk Calculator .  The Pink Ribbon folks at the Susan G. Komen Foundation help you understand some of the statistics & implications of the Gail model .

But as I mentioned yesterday, just because you can (afford to) do a test doesn't mean you should.  After all, what are you going to do with that information?  Worse, what's your insurance company going to do with that information, at least before the pre-existing condition prohibition of the Affordable Care Act kicks in next year !  A couple more points to ponder.  Are you willing to undergo major surgery in an attempt to reduce your cancer risk?  If not, why bother saving for the test?  More importantly, something that Ms. Jolie didn't discuss, who's going to pay for said prophylactic surgeries?  After all, you don't have a disease, just a risk for one, albeit higher than average.  
Don't get me wrong.  I'm not advocating that you avoid or skip the BRCA1/2 tests.  But I am strongly encouraging you to run your own risk assessments using the above risk calculators (I receive no remuneration of any kind from anybody as I am but a lowly state employee) and then discuss the implications w/your family physician and your family.  Together, we can help you make the best decision(s) for you.

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