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Understanding BRCA Test Results

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Published on February 28, 2020

Key Takeaways

  • BRCA testing is important for choosing treatment as well as risk assessment for you and your family.
  • Even for those with a genetic predisposition, lifetime risk is not the same as short-term risk—especially for young women.
  • Take time to talk with your healthcare team about your plans and goals—making decisions about prophylactic surgery is not an emergency.

What does your BRCA test result really mean for your risk of developing breast cancer? Dr. Fred Kass, from the Ridley-Tree Cancer Center, shares how BCRA test results impact treatment decisions, as well as lifestyle and family decisions.

Dr. Kass also explains why young women have more time than they think to make difficult decisions about prophylactic mastectomies and oophorectomies. Watch now to learn more about genetic predispositions, risk assessment and treatment decision-making for breast cancer.

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Transcript | Understanding BRCA Test Results

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrea Hutton:       

Hello. I’m Andrea Hutton from Patient Power, and I’m very happy to be here today with Dr. Fred Kass who’s the Director of Medical Oncology at the Ridley-Tree Cancer Center in Santa Barbara, California.

Dr. Kass:                   

Yeah, happy to be here.

Andrea Hutton:       

Thank you so much for talking to us. You deal with patients who have genetic predispositions?

Dr. Kass:                   

Right.

Andrea Hutton:       

BRCA testing and all that kind of thing. So, how do you talk to patients about what that means? 

Dr. Kass:

Oh, yeah, no, I mean I think the more… 

Andrea Hutton:       

…what do you do prophylactically? 

Dr. Kass:

First of all, there’s lots of reasons to know if some genetic susceptibility is at work. First of all, now affects therapy. There are therapies available specifically for the cancers that arise in patients who have a genetic predisposition. Those cancers are just a little different, and they’re susceptible to certain drugs. So, it’s really important for purposes of therapy to figure that out.

Secondly, there are you know there are other people involved. We have the ability to actually prevent the disease. I think that’s what cancer genetics is all about. It’s about identifying risk so that people at risk can modify it.

Thirdly, I think it clarifies risk. When someone close to you—your mom, your sister, daughter, somebody close to you gets cancer—one of the questions is, “So, do I have to call up other people? How many people need to know? Is this the kind of thing that we’re all going to get?” And being able to clarify that is really helpful.

Fourth, it’s really important to know that—even for women who have a genetic predisposition—and may read there’s a 50 percent lifetime risk of this. Lifetime risks and short-term risks are different. So, talking about this is really important.

When I talk to women in their 30s and 40s who have a genetic predisposition to cancer, it’s really important to know—for them to know—as they make decisions that a 50 percent lifetime risk does not mean there’s a 50 percent risk they’re going to get breast cancer next year. For many of those women, their risk of getting breast cancer in the next five years is less than 5 percent. Much of that…

Andrea Hutton:       

…wait a minute. So, I need to understand that. 

Dr. Kass:                   

If you’re a woman in your 30s with a BRCA mutation and you read there is a 50, 60 percent lifetime risk of my developing breast cancer that risk goes up with time, but it’s not an immediate risk. So, for a woman who comes in in her 30s or earlier and is interested in having a family, the risk of delaying some sort of prophylactic surgery may be very small. We may want that young woman to have some sort of intervention, but it doesn’t have to be tomorrow. That risk is a lifetime risk and graduates over time and—for a really young woman—the risk in the short run is much smaller than she may appreciate. 

Andrea Hutton:       

And what does the curve look like? Is it a gradual incline? Is it a steep incline? What does it look like?

Dr. Kass:                   

So, it starts off relatively gradually and then increases significantly in steepness as we get older. So, it means that for … you know I have families in my practice who are three generations of women we’ve found had BRCA mutations. For the youngest women, we’ve been able to say, “We’ll follow you carefully. You’ll get breast MRI scans. With your type of BRCA mutation, your risk of ovarian cancer is low and your risk of breast cancer in the next five years—given your young age—is extremely low.”

“So, we’ll follow you really carefully, but all those things that you’ve read about—prophylactic mastectomies, prophylactic oophorectomies, we’ll help you. We’ll keep you safe, but you don’t have to do these tomorrow.” And that’s really important for a couple reasons. One is that it gives women a greater sense of, “Yes, I can get married. Yes, I can try to have a child,” although you know and there are these circumstances those things are not guaranteed.

And most importantly in terms of, “What kind of procedure do I want to have? How do I want to approach this? If I have breast surgery, what kind of reconstruction will I have?” Those things do not have to be decided in the heat of the moment. Take six months or a year. We’ll keep you safe in the meantime. Talk to people, interview doctors, think about what you want to do. See how you want to make a life plan. And then when it’s all settled and it feels right, then we’ll do it.

Andrea Hutton:       

Thank you for clearing up a lot of these questions that I had.

Dr. Kass:

All right.

Andrea Hutton:       

And for giving us a lot of knowledge and hope as well.

Dr. Kass:                   

All right. Well, thank you for including me. 

Andrea Hutton:       

Thank you so much for coming. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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