USPSTF supports counseling, BRCA tests for at-risk women

December 24, 2013
USPSTF supports counseling, <i>BRCA</i> tests for at-risk women

(HealthDay)—Nine of 10 women do not need and should not receive genetic testing to see if they are at risk for breast or ovarian cancer, an influential panel of health experts announced Monday.

The U.S. Preventive Services Task Force (USPSTF) reaffirmed its previous recommendation from 2005 that only a limited number of women with a family history of breast cancer be tested for mutations in the BRCA1 and BRCA2 genes that can increase their cancer risk.

Even then, these women should discuss the test with both their family doctor and a genetic counselor before proceeding with the BRCA genetic test, the panel said.

"Not all people who have positive family histories should be tested. It's not at all simple or straightforward," said Dr. Virginia Moyer, the task force's chair.

Interest among women in genetic testing for breast cancer has greatly increased, partially due to Hollywood film star Angelina Jolie's announcement in May that she underwent a double mastectomy because she carried the BRCA1 mutation.

A Harris Interactive/HealthDay poll conducted a few months after Jolie's announcement found as many as 6 million women in the United States planned to get medical advice about having a preventive mastectomy or ovary removal because of the actress' personal decision.

On average, mutations of the BRCA genes can increase breast cancer risk between 45 percent to 65 percent, according to the American Cancer Society.

The problem is that there are myriad mutations of the BRCA gene. Doctors have identified some mutations that increase breast cancer risk, but there are many more BRCA mutations where the increased risk is either low or as yet unknown.

"The test is not something that comes back positive or negative. The test comes back a whole lot of different ways, and that has to be interpreted," Moyer said. "There are a variety of mutations. Often you get what appears to be a negative test but we call it an 'uninformative' negative because it just doesn't tell you anything. A woman would walk away from that with no idea, but worried, and that's not helpful."

Earlier this month, the genetic testing company 23andMe announced it's no longer offering health information with its home-based kit service after the U.S. Food and Drug Administration warned that the test is a medical device that requires government approval.

The new task force recommendations will be published online Dec. 23 in the Annals of Internal Medicine.

The task force's judgment carries heavy weight within the health care industry. For instance, the federal government's list of preventive health care measures that insurers must provide free of charge under the Affordable Care Act is based on USPSTF recommendations.

According to the task force, about 90 percent of American women do not have a family history associated with an increased risk for BRCA mutations, and even fewer will have a mutation that could lead to breast cancer.

"Only two or three women in a thousand have these mutations. Doing this is not going to prevent most breast cancers," Moyer said.

Medical experts are concerned that many women will undergo unnecessary surgery following an unclear genetic test, having their breasts or ovaries needlessly removed to prevent a cancer risk they never had.

"All of us have a copy of the BRCA gene, and some of us have a mutation," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "Some mutations increase the risk of breast cancer by up to 85 percent, others by 40 percent, others by 10 percent."

"But the woman who now knows she has a mutation is very frightened and very upset, and no amount of explaining that it's of little to no significance will help," Brawley continued.

Both Brawley and Moyer emphasized that any woman interested in BRCA screening should meet with a certified genetic counselor before proceeding. The counselor will take a very detailed clinical history of the patient and assess whether they would benefit from the test.

"The key here is that women who think they might want the test should talk to a genetic counselor, and that genetic counselor should explain the risks and benefits of the test and help them make the decision," Brawley said. "A physician shouldn't necessarily be the person doing it. It should be a certified genetic counselor. Most doctors are not skilled at doing this."

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. It routinely issues recommendations about clinical preventive services such as screenings, counseling services and preventive medications.

Explore further: USPSTF: BRCA testing for women with family history

More information: Full Text - Evidence Review
Full Text - Recommendation Statement

Related Stories

USPSTF: BRCA testing for women with family history

April 2, 2013
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) recommends that BRCA1 and BRCA2 genetic testing be limited to women whose family histories are associated with an increased likelihood of having BRCA mutations.

Negative BRCA testing may not always imply lowered breast cancer risk

November 27, 2013
Women who are members of families with BRCA2 mutations but who test negative for the family-specific BRCA2 mutations are still at greater risk for developing breast cancer compared with women in the general population, according ...

Nearly half of breast cancer patients at risk of having BRCA mutations not sent for genetic testing

April 8, 2013
Only 53 percent of newly diagnosed breast cancer patients who were at high risk of carrying a BRCA 1 or BRCA 2 mutation – based on age, diagnosis, and family history of breast or ovarian cancer – reported that their doctors ...

USPSTF: Offer breast CA risk-reducing Rx to high-risk patients

September 24, 2013
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) recommends that women at increased risk of breast cancer be prescribed tamoxifen or raloxifene for risk reduction, according to a final Recommendation Statement ...

Mismatch between cancer genetics counseling and testing guidelines and physician practices

July 25, 2011
A new analysis has found that many doctors report that they do not appropriately offer breast and ovarian cancer counseling and testing services to their female patients. Published early online in CANCER, a peer-reviewed ...

Angelina Jolie's preventive mastectomy raised awareness, but not knowledge of breast cancer risk

December 19, 2013
Angelina Jolie heightened awareness about breast cancer when she announced in a New York Times op-ed that she had undergone a preventive double mastectomy. But a new study led by researchers in the University of Maryland ...

Recommended for you

Single blood test screens for eight cancer types

January 18, 2018
Johns Hopkins Kimmel Cancer Center researchers developed a single blood test that screens for eight common cancer types and helps identify the location of the cancer.

Researchers find a way to 'starve' cancer

January 18, 2018
Researchers at Vanderbilt University Medical Center (VUMC) have demonstrated for the first time that it is possible to starve a tumor and stop its growth with a newly discovered small compound that blocks uptake of the vital ...

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.

The pill lowers ovarian cancer risk, even for smokers

January 18, 2018
(HealthDay)—It's known that use of the birth control pill is tied to lower odds for ovarian cancer, but new research shows the benefit extends to smokers or women who are obese.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.