Knowing your genetic risks for cancer might seem scary. However, by taking a genetic cancer test, you will have even more peace of mind, because you will have a powerful tool to help prevent it.
Stephanie Blank, MD, Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai and Director of Gynecologic Oncology for the Mount Sinai Health System, answers some common questions about genetic cancer tests. Dr. Blank is also Director of Women’s Health at the Blavatnik Family Chelsea Medical Center at Mount Sinai and Associate Director in The Tisch Cancer Institute at Mount Sinai with a focus on women’s cancers.
What are hereditary cancers?
Hereditary cancers are cancers you may be more likely to get due to a pattern in one of your genes. If you have a mutation in a certain gene, you may be at a higher risk for cancer. Some of the most common mutations associated with cancer are BRCA 1 and 2. If you have a mutation in one or both genes, you have an increased risk of breast and ovarian cancers.
How do you determine if you are at risk for hereditary cancer?
Family history is important, and there are a few different elements you need to know. It’s important that you know both the maternal and the paternal side of your family history, if those relatives had any cancers, what cancers they were, the ages of family members at diagnosis of those cancers, as well as their age of death, regardless of whether it was from cancer or not. When you have your family history and draw it out in a tree, you may notice many areas where there are relatives who had cancers, and you can trace that. Another important thing to know is if any family members had genetic testing and their results.
What would be considered a risk factor in someone’s family history?
Some red flags include relatives who got cancer extremely young or multiple family members who got the same cancer, including individuals who got more than one cancer and unusual cancers. In that situation, it is important to know the age of the family member’s diagnosis, and if they had any genetic testing done.
Does my ethnic background increase my risks for genetic cancer?
People from certain ethnic backgrounds, such as those who are Ashkenazi Jewish, may be at increased risk of having a genetic mutation, but there are others, including French Canadian and Icelandic—and we are always discovering more.
How do I find out for sure if I am at risk for hereditary cancer?
If you think you might be at increased risk of cancer based on your family history or ethnicity, speak with your doctor about how to get tested. At Mount Sinai, we provide both genetic testing and genetic counseling. In addition to testing, genetic counseling can help determine if you have one of these mutations. Oftentimes, you may see a genetic counselor either prior to getting the testing or afterwards. Testing generally consists of a blood test but can also be a swab from the inside of your cheek. If you do have a mutation, we can use that information to help you plan for how you are going to screen for or prevent cancer.
Will my health insurance cover the costs of genetic cancer testing?
Health insurance typically covers genetic testing, but you should confirm this with your health insurance provider. If your provider does not cover it, Mount Sinai’s genetic counselors can work with you to minimize the cost.
Why should I get tested to find out if I am at risk for hereditary cancer?
If you know your risk, there is a lot you can do to help yourself. If you have a BRCA 1 mutation, for example, you know you are at higher risk for several cancers, breast and ovarian being the most common, as well as pancreatic and prostate cancer. If you are a woman with a BRCA 1 mutation, you can start getting mammograms and magnetic resonance imaging early. Even if you do not have cancer yet, you might consider medication and even surgery to prevent breast cancer from forming.
If you have a genetic risk for ovarian cancer, you might go on birth control pills, which diminish the risk of ovarian cancer. Even if you already have ovarian cancer, we recommend genetic testing, because around 25 percent of ovarian cancer is genetic. Knowing if you have the mutation has a profound effect on your care, since we use different treatments depending on whether the cancer is genetic. Knowing if your cancer is genetic is even more important for determining prognosis. If you have a mutation, it is important that you tell your family members, so they can get tested and take measures to reduce their own risk.
Are most cancers genetic?
Most cancers are not genetic. Not having a mutation does not mean you won’t get cancer; we just don’t know what the likelihood is. When somebody has a mutation, we know a lot more about the likelihood of getting cancer, or the age at which they might get cancer. Hereditary information and knowing your risk of cancer is an opportunity to prevent it.