Genetic testing a means to enlighten patients for screening and treatment decisions
October Breast Cancer Awareness
Breast cancer is not unlike a house fire — hard to predict, devastating to experience and recovery requires professional guidance and personal resolve.
The house can be rebuilt, and stand for years to come, but nothing is ever again quite the same.
Just ask any breast cancer patient. Or their doctor or surgeon.
Though only 5% to 10% of all breast cancers are due to an inherited mutation, Arizona Oncology Dr. Iyad Hamarneh in Prescott Valley is an advocate of genetic testing for those whose family history might require them to be more vigilant, or at least aware so they can make choices that suit their life.
Medical science and technology is still evolving as it comes to identifying all possible mutations, but some of the standard genetic tests that a young female patient might undergo to detect an early breast cancer can also be used to identify ovarian and other female-related cancers. In males with breast cancer history in their families, genetic testing may be suggested as a predictor of such things as prostate, even pancreatic cancer, Hamarneh said.
Unlike in women where heredity is not a prime predictor of breast cancer, Hamarneh said the opposite is true for men. Though rare, male breast cancer tends to be related to genetic disorders; again, those genes can also be predictors of other cancers, he said.
Patients diagnosed with breast cancer, the majority of which are women, may also want to undergo genetic testing as a means to learn more about the mutations that have prompted the cancer, national experts suggest. Such knowledge can help determine suitable surgery and treatment — lumpectomy to immunotherapy, radiation to daily hormonal therapy medications. The genetic tests can assist oncologists with analyzing the type of cancer tumors in the body, and can help predict future incidents that can lead patients to make decisions about such things as prophylactic mastectomies, local and national experts concur.
At Arizona Oncology, Hamarneh said their practice has the availability of genetic counselors able to meet with patients to go through their family tree, and potential inherited mutations that could lead to a cancer diagnosis. The counselors, too, strive to be a comfort to patients so they don’t panic upon hearing results, positive or negative, and rather carefully contemplate their choices because not everyone with an inherited gene ends up with a cancer diagnosis, Hamarneh and other experts advise.
The actual genetic tests are relatively simple, standard blood draws and saliva swabs, Hamarneh said. Arizona Oncology works with a national laboratory that is able to analyze the tests and return results within a few weeks, he said. Arizona Oncology tests for about 20 different cancer mutations, including those for aggressive types of heredity-based cancers and ones that could predict other types of cancer that individuals might need to monitor on a routine basis, he said.
Yavapai Regional Medical Center does not at this time have a genetics lab, though BreastCare Center medical staff anticipate such a laboratory will eventually be available to their patients.
So what happens after the test results return?
Hamarneh admits the next phase can be a disconcerting one.
At his practice, Hamarneh said the focus is always on equipping patients with the information they require to make good decisions. He said they will even provide patients with a written letter explaining the genetic test results so they have a better understanding of the implications.
“We talk risks, and we talk about other cancers associated with that genetic mutation, and we offer genetic counseling to family members,” Hamarneh said.
As a patient-focused physician, Hamarneh said he always defers to the patient to decide what is best, be that a high risk surveillance protocol with additional mammograms, ultrasounds and MRIs (Magnetic Resonance Imaging. Some patients may opt for treatment with medications to limit or lessen risks of a second bout of cancer; some with risks that are 60% or higher for diagnosis may opt for preventative surgery, he said.
Hamarneh and other national experts are also clear that testing positive for a hereditary disease does not mean the individual will be diagnosed with cancer. Any screening or treatment options need to be tempered with that reality, they said.
The value, however, of genetic testing is one that Hamarneh appreciates: offering a patient tangible information to keep them in good health, and hopefully, assure early detection of a cancer.
“To have a good (review) of family history is very important,” Hamarneh said. “It gives patient options … and then they decide on treatment based on their risk.”