Dr. Parker shares how he knows when a woman has the gene that may lead to her getting a hysterectomy.
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Gene testing can be done now for both breast cancer and ovarian cancer and it’s one gene, it’s called BRCA-1 and BRCA-2, it’s a family of genes. Basically, you would ask for this testing if you have a family history, if you’ve had a mother or sister with breast or ovarian cancer, especially if they had been diagnosed at a young age. For instance, if your great grandmother had breast cancer at age 70, that’s not a genetic issue, but if your aunt had breast cancer at age 70 that’s not a genetic issue, but if your mother had breast cancer at age 40, our antenna would go up and we’d start thinking about the possibility of a genetic breast cancer or ovarian cancer. The gene tends to be more prevalent among Ashkenazi Jews and the less prevalent in the general population. In the general population it’s two out of a thousand women will have this gene and in the Ashkenazi Jewish population it’s about two out of a hundred, so ten times greater risk. So, especially if you’re Ashkenazi Jewish and you have a relative with breast or ovarian cancer, we would probably recommend you get at least genetic screening by a geneticists and they will draw a family tree and tell you ‘yes, it’s a good idea to get tested’, or ‘no, it’s not’. The testing is simple. It’s a simple blood test, but repercussions of the test, and this is what the Genetic Council talks about, are great, because if you have the gene you have a very high risk of breast or ovarian cancer. If you don’t have the gene you’re back in the regular pool like everybody else, very low risks of both of those diseases, but it’s a real emotional issue for women that have the gene. I am just going to tell a brief story. I have a patient who had a small breast cancer on one side and thought nothing of it and then about five years later got another breast cancer and was recommended to have gene testing. It turned out she was gene-positive. She had three daughters. Her oldest daughter was married, had two children. Her middle daughter was just getting married, no children; and her third daughter who was a physician, was planning never to get married and never have children. Each of those girls made a different decision. The daughter who was older, had completed her family, chose to be tested, lucky she was negative. The daughter who would not gotten married yet, was engaged, decided not to be tested because she felt that if she was positive, she was not ready to go have her ovaries removed or have breast surgery to take her breasts off, which is the extreme treatment for this, and she has not yet been tested; she now has her second child. The third daughter who was the physician, was tested, was positive and chose to have her ovaries removed and breasts removed, knowing she was never going to have a family, but was physician and was very cognisant of what the risks would be to her health and her life and decided to have that. So I think every situation is different and that’s what the genetic counselors do wonderfully well is go through with you what these options are and what your choices can be.
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