The Fraser Medical Clinic is committed to providing the best possible preventative care for our patients. This requires careful attention to evolving guidelines regarding best practices.
I would like to take a moment to explore the recently published United States Preventative Services Task Force or USPSTF recommendations regarding genetic testing for breast cancer risk.
Medical testing is now available for the BRCA 1 and BRCA2 genes. If one or both of these genes is defective a woman’s estimated lifetime risk of breast cancer increases from an average of 12.5% in the unaffected population to a range of 45-65%. With defective BRCA genetics ovarian cancer risk increases from a lifetime average of 1.4% to 10-35%. Women who are identified as high risk can benefit from options such as more frequent or technologically advanced cancer screening, risk reducing medications, and risk reducing surgery.
The newly published guidelines states that women who have family members with cancer of the breast, ovaries, fallopian tubes, lining of the pelvis or abdomen, or any BRCA-genetic related cancer should use a risk assessment questionnaire, and women with positive screening risk questionnaires should be offered genetic counseling. The USPSTF does not recommend genetic testing for women with average breast cancer risk.
There are 5 acceptable versions of a risk assessment interview. These are the Ontario Family History Assessment Tool, the Manchester Scoring System, the Referral Screening Tool, the Pedigree Assessment Tool (PAT) and the FHS-7 Tool. Of these, the FHS-7 is the easiest to use, as a single yes answer to any of these questions is an indication for genetic testing.
The FHS-7 Breast Cancer Screening Tool
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Did any of your first-degree relatives have breast or ovarian cancer? |
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Did any of your relatives have bilateral breast cancer? |
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Did any man in your family have breast cancer? |
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Did any woman in your family have breast and ovarian cancer? |
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Did any woman in your family have breast cancer before age 50 y? |
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Do you have 2 or more relatives with breast and/orovarian cancer? |
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Do you have 2 or more relatives with breast and/or bowel cancer? |
You can review all of the tools mentioned above on the USPSTF website here: http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrstab.htm#tab5
Testing for the BRCA 1 and BRCA 2 is approximately $3500 and is only sometimes covered by medical insurance.
We would be happy to review this with you at an appointment, and can coordinate genetic testing and genetic counseling for you.