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HFO is pleased to announce a new alliance with Vericare, a national provider of mental health care services. HFO will be Vericare's new resident recommended CE provider, offering their service providers a discount and the ability to track and file their CE progress for Vericare's accreditation.
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Buy "The Psychosocial Needs of Women Undergoing Genetic Counseling and Testing for BRCA1/2" now and save $10 off the purchase price.
Use promo code HFOGENETICS at checkout
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BRCA1/2 Genetic Testing: Who’s a Candidate?
 Since 1995, genetic testing for hereditary breast and ovarian cancer has been clinically available, allowing health care providers to identify individuals who carry deleterious germline mutations placing them at increased risk for developing hereditary forms of breast and ovarian cancer. The majority of hereditary breast cancers are associated with mutations in BRCA1 and BRCA2 (BRCA1/2) tumor suppressor genes and account for about 5-10% of all cases of breast cancer.1-2 This translates into between 8,000 to 17,000 new BRCA1/2 related breast cancer cases in a given year.3
A recent study of cancer risks in BRCA1/2 mutation carriers in a large U.S. based sample estimated the cumulative breast cancer risk at age 70 years to be 46% in BRCA1 carriers and 43% in BRCA2 carriers. Cumulative ovarian cancer risk was 39% in BRCA1 carriers and 22% in BRCA2 carriers.4 Thus, the lifetime risks for both breast and ovarian cancer for BRCA1/2 positive women far exceed the general population risk of 13% for breast cancer and 1.4% for ovarian cancer.
In general, women with at least a 10% probability of carrying a BRCA1/2 mutation are candidates for genetic testing.5-6 There are several well validated risk assessment models that can help to identify those individuals who may benefit from BRCA1/2 genetic counseling and/or testing.7 The National Comprehensive Cancer Network (NCCN) has established a set of clinical guidelines for referral to a cancer genetics professional for assessment of hereditary cancer risk.8
NCCN Guidelines for BRCA1/2 Genetic Testing Referrals 8
Referrals are recommended for women who have:
- Been diagnosed with early-age-onset breast cancer (prior to age 50)
- Bilateral breast cancer
- Both breast and ovarian cancer
- A family history that includes a clustering of breast and ovarian cancers
- A previously identified mutation in the family
- An Ashkenazi Jewish bloodline with these personal or family cancer histories
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Featured Course
The Psychosocial Needs of Women Undergoing Genetic Counseling and Testing for BRCA1/2
(2 CEs) by Susan T. Vadaparampil, PhD & Gwendolyn P. Quinn, PhD
 As BRCA1/2 testing continues to move from research settings into mainstream clinical practice, health care professionals will increasingly encounter patients who have undergone BRCA1/2 genetic counseling and testing or are considering it. Moreover, a recent bill passed by the Senate and supported by the White House would set new standards to safeguard genetic privacy; barring companies from using genetic information to deny health coverage or employment. This legislative development may increase the interest in genetic testing. Click here to read more about this proposed legislation.
Therefore, it is vital that health care professionals are informed about cancer risk assessment as well as the purpose, interpretation, and outcomes of cancer genetic testing.9 Health care professionals must also be aware of the pre- and post-testing psychosocial and behavioral issues related to cancer genetic testing when caring for patients.
These can include:
- Facilitating the initial decision about whether or not to be tested.
- Helping patients decide whether or not to communicate test results to family, and if so, how best to do that.
- Counseling patients about the consequences with regard to children, and among patients of child bearing age, assisting with family planning.
- Managing test result-related distress and anxiety.
- Assisting with decisions regarding medical risk-related strategies.
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This online CE course reviews the BRCA1/2 genetic counseling and testing process, test results and their implications, and risk management strategies for BRCA1/2 mutation carriers. Further, it summarizes the psychosocial impact of genetic counseling and testing, and presents strategies for assessing the psychological impact of BRCA1/2 counseling and testing in clinical practice.
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About the Authors
 Susan T. Vadaparampil, PhD - Assistant Professor, Department of Interdisciplinary Oncology, University of South Florida (USF) College of Medicine and Member-In-Residence in the Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center. Adjunct Faculty, USF College of Public Health and Adjunct Scientist, Clinical Genetics Branch, NCI. Collaborator/co-investigator on several nationally-funded studies in the areas of physician knowledge and use of genetic testing for inherited cancer susceptibility, establishing the prevalence of BRCA1/2 mutations in the African American population, psychosocial aspects of familial testicular cancer, health care provider discussion of fertility preservation among pediatric and young adult cancer patients and their families, and the psychosocial impact of HPV on men. Interests: Awareness, knowledge, and use of genetic testing for inherited cancer susceptibility in the general population, minority groups, physicians, and at-risk populations.
 Gwendolyn P. Quinn, PhD – Associate Professor, Department of Interdisciplinary Oncology, College of Medicine, University of South Florida. Director, National Training Collaborative for Social Marketing, a cooperative venture of the Centers for Disease Control and Prevention and the American Association of Medical Colleges and Co-director, Survey Methods Core, H.Lee Moffit Cancer Center and Research Institute. Interests: Assessing the behavioral determinants of consumer decisions and choices about health; understanding and overcoming provider-based barriers to discussing fertility preservation with cancer patients; promoting the use of folic acid among Hispanic women; preventing smoking relapse among pregnant and postpartum women; understanding the barriers to patient accrual to cancer clinical trials; and promoting knowledge and awareness of clinical trials among newly diagnosed patients. |
References
- Miki, Y., Swensen, J., Shattuck-Eidens, D., Futreal, P. A., Harshman, K., Tavtigian, S., et al. (1994). A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science, 266(5182), 66-71.
- Wooster, R., Bignell, G., Lancaster, J., Swift, S., Seal, S., Mangion, J., et al. (1995). Identification of the breast cancer susceptibility gene BRCA2. Nature, 378(6559), 789-792.
- ACS. (2007). Cancer facts and figures - 2007. (ACS Publication No. 5008.07). Atlanta, GA: American Cancer Society.
- Chen, S., Iversen, E. S., Friebel, T., Finkelstein, D., Weber, B. L., Eisen, A., et al. (2006). Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol, 24(6), 863-871.
- ASCO. (1996). Statement of the American Society of Clinical Oncology: genetic testing for cancer susceptibility, Adopted on February 20, 1996. J Clin Oncol, 14(5), 1730-1736; discussion 1737-1740.
- Hampel, H., Sweet, K., Westman, J. A., Offit, K., & Eng, C. (2004). Referral for cancer genetics consultation: a review and compilation of risk assessment criteria. J Med Genet, 41(2), 81-91.
- Parmigiani, G., Chen, S., Iversen, E. S., Jr., Friebel, T. M., Finkelstein, D. M., Anton-Culver, H., et al. (2007). Validity of models for predicting BRCA1 and BRCA2 mutations. Ann Intern Med, 147(7), 441-450.
- Daly, M., Axilbund, J. E., Bryant, E., Buys, S., Eng, C., Friedman, S., et al. (2006). The NCCN Genetic/Familial High-Risk Assessment: Breast and Ovarian Clinical Practice Guideline, version 1.2006. Available at http://nccn.org/physician_gls/indiex.html. Accessed November 19th, 2006. To view most recent and complete version of guideline, to www.nccn.org. Retrieved November 19th, 2006, 2006.
- Pasacreta, J. V., Jacobs, L., & Cataldo, J. K. (2002). Genetic testing for breast and ovarian cancer risk: the psychosocial issues. Am J Nurs, 102(12), 40-47; quiz 48.
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