Prevention and Early Detection
Breast and Ovarian Cancer Genetic Risk Assessment

The purpose of the Breast and Ovarian Cancer Genetic Risk Assessment program is to help women understand their inherited genetic risk of developing breast and ovarian cancer. This information may then be used to educate women about appropriate screenings to detect cancer and to encourage certain health promotion behaviors. In addition, physicians may use this information in early detection and treatment of cancers.

Breast cancer is the most common form of cancer in North American women, excluding skin cancers, and the second leading cause of cancer death, surpassed only by lung cancer. Although ovarian cancer represents only four percent of women's cancers, it causes more deaths than any other cancer of the female reproductive system.

Facts on hereditary Breast and Ovarian Cancer
One in every eight women in North America may develop breast cancer in her lifetime. Some women may be at greater risk due to a number of factors, one of which is genetics. Breast cancer is one of the most common forms of cancer in North American, affecting nearly 211,300 women a year. Although many women have a family history of breast cancer, only a small percentage of cases is known to be caused by inherited mutations in cancer susceptibility genes. An estimated seven percent of breast cancers are caused by harmful alteration in inherited genes.

Ovarian cancer affects nearly 25,400 women each year, representing about four percent of women's cancers. Approximately ten percent of ovarian cancer is caused by by harmful alteration in inherited genes.

Although seven and ten percent may sound like small numbers, inherited genes are responsible for approximately 16,000 new cases of breast and ovarian cancer each year in the United States.

Cancer Genetic Risk Assessment Program

Our program offers information; counseling; genetic testing, if necessary to women 18 years of age or older who have a strong family history of breast or ovarian cancer; and long-term follow-up. Genetic testing screens women at high risk for breast or ovarian cancers to determine if they have genetic markers for the disease. Either parent can pass on a genetic predisposition for certain types of cancer.

Individuals can be referred to our program by their physicians. However, women may refer themselves but each patient must have a primary physician with whom to discuss results, screening recommendations, and follow-up. If a primary physician is not available, we will provide you with several suggestions.

Who Should be Referred?

The following questions deal with common hereditary characteristics and may help you determine if you should be referred to this program.

Have you:
been diagnosed with breast cancer before age 50?	Yes	No
been diagnosed with ovarian cancer (at any age)?	Yes	No

Do you:
have relatives who have been diagnosed with breast cancer before age 50?	Yes	No
have relatives who have been diagnosed with ovarian cancer (at any age)?	Yes	No
have two or more relatives on the same side of the family who have been diagnosed with breast or ovarian cancer?	Yes	No
have relatives who have been diagnosed with male breast cancer?	Yes	No
Are you of Ashkenazi Jewish descent (Central or Eastern European)?	Yes	No

If you answered "yes" to any of these questions or if you have questions about your family medical history, you may want to ask your physician or other health care professional for more information about assessing your cancer risk.

Our Services
This process begins before your first appointment. Over the phone, we'll take a brief history and explain our services. If further screening is recommended, an appointment will be made for you. Family members are encouraged to accompany you.

Our services include:

• Explanation of the genetic testing process
• A detailed review of your family history, medical history and personal risk factors
• Comprehensive education on lifestyle management, cancer screening, and general health
• Development of a personal plan for prevention and early detection in collaboration with your physician.
• Psychological counseling

Health Care Team
Assessing one's risk for breast and ovarian cancer can be a very intimate and emotionally complex process that is best handled with a team approach. The Cancer Genetic Risk Assessment program is staffed by a medical director, an advanced registered nurse practitioner, and psychologist. This staff is supported by an advisory committee of medical, surgical and radiation oncologists; oncology nurses; psychologists and clergy.

Genetic Cancer Testing
In 1996, the American Society of Clinical Oncology recommended that genetic susceptibility testing be offered for individuals who have a strong family history of cancer or very early onset of disease.

If we believe, based on your family history, that a genetic mutation may be responsible for increasing your risk of developing a cancer, we'll offer genetic testing. If you decide to proceed with genetic testing for predisposition to cancer of the breast or ovary, a blood sample will be taken for analysis. Results will be available within three to four weeks.

Once the results are obtained, a thorough explanation of the results will be given. If the test reveals the presence of a mutated gene, physicians and counselors will recommend a personal plan for prevention and early detection.

Fees
There are fees for the counseling, education, screening, and laboratory testing. Some insurance companies pay for these services. If not covered, there will be a charge to you to cover costs associated with this testing.

Patient Confidentiality
All family information and genetics testing results are confidential. We will not release such information to anyone without your written consent. Please note however, we may be required to provide certain information to your insurance company in order to secure payment for these screening and testing services.

Sister Study
You may be able to volunteer for the Sister Study if each of the following statements are true for you.

• You are a woman between the ages of 35 and 74.
• You have never been told you have breast cancer.
• You have a sister related to you by blood who has had breast cancer.

The Sister Study is a long-term study investigating the effect of genetics, the environment and lifestyle on the risk for breast cancer and other diseases in sisters of women with breast cancer. The study is being conducted by the National Institutes of Health (NIH) through the National Institute of Environmental Health Sciences (NIEHS). For more information about this study, go to The Sister Study website.