Angelina Jolie’s recent revelation about having her ovaries removed once again has had women thinking about cancer risk, cancer prevention and genetic testing. Her decision to have her ovaries and fallopian tubes removed has made national headlines and for good reason. Angelina knew her estimated risk for ovarian cancer and was regularly having tests to identify early changes that could indicate that a cancer had developed. Angelina knew her risk because she previously had genetic testing and a cancer predisposition gene mutation was identified. Her gene mutation was in the BRCA 1 gene, which increased her risk for breast and ovarian cancer. However, this gene is not the only gene in which mutations can raise the risk for ovarian cancer. Women (and men) with a family history of certain cancer can consider testing for other mutations in cancer predisposition genes. Hunterdon Regional Cancer Center has a comprehensive Family Risk Assessment Program which offers genetic testing. The options offered for genetic testing for hereditary risk for cancer have changed in the past two years and expanded tests are available. If they had prior testing for mutations in the BRCA genes and no mutations were identified, additional testing may be considered. This includes additional gene tests associated with ovarian cancer.
Of all cancers diagnosed, 70 percent are sporadic or occurring for reasons related to factors such as age, lifestyle, or environmental exposures. About 20 percent are familial, meaning several people in a family have the same kind of cancer, but not because they inherited it in their DNA. It could be because they shared a lifestyle such as smoking, similar diet, alcohol intake or obesity.
“Approximately 10 percent of all cancers are due to a gene mutation, which can be inherited from either parent,” says Rachel Rando, Certified Genetic Counselor at the Family Risk Assessment Program for the Hunterdon Regional Cancer Center. This has proven to be true with breast and ovarian cancers as well as colon, kidney and uterine cancer and melanoma. “BRCA 1 and BRCA 2 genes are just two genes among many that are associated with breast and ovarian cancer. Here at the Hunterdon Regional Cancer Center’s Risk Assessment Program, testing for cancer predisposition includes a thorough evaluation of your personal and family history to determine the extent of genetic tests offered to you. Many of our program participants choose to have tests that include other genes. As a result, we have identified increased cancer risk in families who do not have a BRCA gene mutation.
According to Mary Vecchio, one of the two Advanced Practice Nurses providing care in the Family Risk Assessment Program, “These families may choose the same option as Ms. Jolie; that is having ovaries and fallopian tubes removed to reduce the risk. But as you can imagine this is not always an easy decision to make. In a premenopausal woman, this surgery results in significant hormonal changes. It alters your family planning choices and may result in physical changes. We offer a thorough discussion of the benefits and limitation of this surgery to assist in the decision making.”
An important element of the story shared by Angelina Jolie deserves further explanation. It is reported that she had changes in bloodwork biomarkers that were suggestive of a developing cancer. No cancer was identified at the time of surgery. At this time, as highlighted by this example, there is no accurate means of screening for ovarian cancer. Women who have an elevated risk for ovarian cancer (as estimated by bloodwork and/or family history) are offered the tests as an option. Many know that like Angelina Jolie, they may eventually choose to have surgery to reduce their risk. For many, this offers more confidence in risk reduction, than regularly having biomarker tests with results that may suggest cancer when it is not there or fail to identify a cancer that is present.
Angelina Jolie’s willingness to share her experience is courageous. It empowers women who know their risk, and women who suspect they may have a genetic mutation in one of the two BRCA genes. The staff of the Family Risk Assessment Program at Hunterdon Regional Cancer Center encourages families with a family history of ovarian cancer to empower themselves as well. Families who have had BRCA testing without identification of a mutation should consider further evaluation of additional gene mutations associated with ovarian cancer.
If someone has an inherited mutated gene predisposing them to cancer, there’s a 50-50 chance their siblings and each of their children also have it. The counseling provided though the Family Risk Assessment Program offers the opportunity to decide if testing is appropriate and desired. It may be determined that perhaps another family member is a better candidate for genetic testing. Those who do pursue genetic testing and discover they have a mutated gene can do some things to reduce their risk for ovarian, breast or other cancers, or to detect it at an early stage. A healthy diet and regular exercise are encouraged., There also are medications that can be taken to reduce risk of some cancers.. Some women choose surgical prevention such as having both breasts (risk reduction mastectomies) or their ovaries (oophorectomies) removed before they develop that type of cancer. Some women delay that decision, or never elect for surgery.
Decisions about cancer risk management and prevention are personal and can change over time. The Family Risk Assessment Program invites everyone to learn more about their risk even if they don’t choose to have genetic testing. “The evaluations, management strategies, education and support provided can make a difference and empower families” notes Ms. Rando.
For information on the Family Risk Assessment Program, contact Rachel Rando, Genetic Counselor, at (908)788-2566orRando.Rachel@hunterdonhealthcare.org or Mary Vecchio at (908) 788 -2546 or firstname.lastname@example.org. For more information on Hunterdon Regional Cancer Center, visit www.hunterdonhealthcare.org.