Although the process of genetic testing for cancer starts out with a simple blood draw, the topic of genetic testing is anything but simple.
The test comes with a whole minefield of possible emotional aftershocks, especially for those who receive a positive or ambiguous result. When considering genetic testing, it’s important to weigh all the pros and cons with a trusted physician. Most doctors will also recommend that families visit a genetic counselor before seeking the actual testing.
Considering the Cons of Genetic Testing
No medical risks are associated with genetic testing for breast and ovarian cancer, but test results can have a great affect on your life.
· Emotional health — Both positive and negative test results can affect emotional health. Some studies indicate that people who receive a positive result are more likely to feel anxious about cancer. Although no studies have looked at how frequently this occurs, the National Cancer Institute reports that some individuals who have negative results experience survivor’s guilt.
· Medical decisions — A positive or negative test may affect what screenings or preventive steps a woman will choose to take throughout her lifetime. Those with a positive test result can choose from preventive actions that range from surgery to increased surveillance.
· Discrimination — The Genetic Information Nondiscrimination Act of 2008 protects individuals from discrimination initiated by an employer or health insurance company. But the law does not include protection against discrimination when obtaining life insurance, short-term disability insurance or long-term care insurance. Those who test positive for a BRCA1 or BRCA2 gene mutation may struggle to acquire these types of insurance.
It’s also important for families who are deciding whether to test or not to know that the results do not indicate with any certainty whether an individual will or will not be diagnosed with breast or ovarian cancer. The average American woman has a 12% chance of developing breast cancer in her lifetime. A positive test result means a 14% to 87% risk of developing breast cancer.
In about 10% of tests, the results are ambiguous. This typically means that the test wasn’t able to identify one of the known BRCA1 or BRCA2 mutations that are linked to an increased risk of breast or ovarian cancer, but a genetic variant was discovered. People with an ambiguous test result are encouraged to talk to their physician about how to interpret these results.
Considering the Pros of Testing: Emotional Health
Although some studies link testing to an increase in anxiety, several others have found an association between declining to test and depression. One study found that among people with a significant family history of breast and ovarian cancers, those who declined testing had a significant increase in depressive symptoms 1 month after declining testing (from 26% at the time testing was offered to 47% at 1 month after declining the test). Reported symptoms of depression remained the same among those who opted for testing. According to the National Cancer Institute, it’s not uncommon for individuals who choose testing to feel more “in control” of their health. Genetic testing allows individuals to take a proactive approach to their medical care.
Considering the Pros of Testing: Physical Health
Remember, a negative test does not mean that the individual will not be diagnosed with breast cancer, nor does a positive test guarantee an eventual breast cancer diagnosis. But genetic testing can provide individuals the information they need to make important decisions about medical care.
Those with a positive test can opt for any of a variety of prevention options, including:
· Increased surveillance — The earlier cancer is caught, the more treatable it is. For most women, an annual mammogram starting at age 40 is recommended, as are annual gynecological visits beginning during the teenage years. For those with a BRCA1 or BRCA2 mutation, experts recommend beginning annual mammography at least 10 years prior to the earliest age of diagnosis within the family. Memorial Sloan-Kettering Cancer Center in New York recommends a clinical breast exam every 6 months. Women should consult their physicians about other methods of surveillance, such as MRIs.
· Chemoprevention medications — As the name suggests, chemoprevention drugs are medications that are designed to lower one’s risk of developing cancer. Two of the commonly prescribed chemoprevention medications — Nolvadex (tamoxifen) and Evista (raloxifene) — are approved for use among women over 35. It is recommended that these drugs be used for no longer than 5 years. A National Cancer Institute study found that “Tamoxifen reduced the risk of invasive breast cancer by 49% in women at increased risk for developing the disease.” But few studies have been conducted to determine how these medications impact those with specific BRCA1 and BRCA2 mutations. Be sure to talk to a physician about possible side effects associated with medications such as tamoxifen and raloxifene. Tamoxifen has been linked to a host of side effects, including nausea, hot flashes and in rare cases, an increased risk of endometrial cancer.
· Prophylactic surgery — This step involves the removal of tissue that is at risk for cancer before the cancer develops. Those with a BRCA1 or BRCA2 mutation can choose preventive mastectomy, hysterectomy, removal of ovaries and fallopian tubes, or any combination of these procedures. Prophylactic surgery has been shown to reduce the risk of breast and ovarian cancers by 90%.
This article was copied from About.com. and was reposted on my blog. There has been a lot of conversation about this topic in the news lately. There are so many things to consider when trying to make this decision and I felt it was imperative to bring this information to my readers. As always, I ask you to read with an open mind, it is all about education and information.
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