Thank you...
Nature or nurture?

Dear Nature or nurture?,

It may be reassuring to know that a family history of cancer does not mean that cancer is inevitable. Although family history and age are indicators of increased risk, family history alone is by no means the only determinant of cancer.

Both men and women have BRCA1 and BRCA2 genes (short for BReast CAncer Gene 1 and 2), but it is the mutation of these genes that is associated with an increased risk of breast and ovarian cancers. Men and women with altered versions of BRCA1 or BRCA2 are at a higher risk of developing breast cancer compared to men and women who have normal BRCA genes. However, only 4 to 9 percent of breast cancer diagnoses made each year are thought to be inherited, and only a fraction of these cases have been linked to BRCA gene mutations. Breast cancer continues to be rare for men, however, even if they have an altered BRCA1 or BRCA2 gene. Individuals who have a personal or family history of breast cancer, particularly if breast cancer has been present in two or more close relatives, multiple generations, or if the breast cancer developed at early ages, may want to consider genetic testing to learn more about her/his personal cancer risks.

It sounds like you've made the choice to learn more about the testing process, and your health care provider or genetic counselor should be able answer your questions and discuss your concerns. You also may want to think about how the results of genetic testing will impact your life. What support systems do you have in place to help you understand the results and cope with the feelings that may accompany a positive or negative result? Not all of BRCA gene mutations carry the same amount of risk, so a genetic counselor will be particularly helpful in assessing your medical health, lifestyle, and family history. A genetic counselor can also work with you to create a strategy for managing your personal cancer risks. If you decide that genetic testing is an option you'd like to take, only a blood sample is required, but results may take several weeks or even months.

While the results of the test may be informative, the test also has limitations. Most notably, a negative result is not a guarantee that cancer will not eventually develop, and finding an altered BRCA1 or BRCA2 gene will not indicate if or when breast cancer will develop. However, knowledge of a BRCA mutation would signify the need for more careful monitoring by your health care provider. Some risk management options include frequent clinical breast exams and mammograms, and possibly lifestyle changes, such as changes in diet and exercise. It has also been shown that drugs such as tamoxifen and raloxifene, taken over the course of 5 years, have been effective in reducing breast cancer among high risk women, although it is unclear whether this is true for women with BRCA mutations. Finally, some women choose to have preventative surgery to remove healthy breast tissue, known as a prophylactic mastectomy. If you discover you are at high risk for developing breast cancer, having an honest conversation with your genetic counselor or health care provider about what preventative actions are right for you may give you some peace of mind.

Accessing your mother's medical records may not be necessary at this point. If at any time you are referred to a cancer specialist, however, it might be helpful to have her/him look at those records, if they are still available. To have them released, you will most likely need to write a letter or fill out a request form to your mother's primary care provider. Depending on the medical facility and the laws governing them, you may or may not have access to these files.

For more information, you can also visit the National Cancer Institute's (NCI) Genetic Testing for Breast Cancer Risk website or call the NCI's Cancer Information Service (CIS) at 1.800.4.CANCER (422.6237) for more information. The National Cancer Institute can also help you to stay informed of available options.

It's admirable that you are exploring options with consideration of your present and future personal health. Best of luck reaching a conclusion that supports your health and happiness. 

Alice

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