Oregon promotes awareness of breast cancer

The Oregon Public Health Genetics program has received a grant to educate members of the Jewish community about hereditary breast and ovarian cancer and their potential for increased risk of developing those cancers.

“This program worked on education materials, contracted with a geneticist from OHSU (Oregon Health & Science University) to create a presentation and training targeted to members of the Jewish community to know their risk and the preventative measures that can reduce the risk of developing cancer, as well as linking members of the Jewish community to national resources such as Sharsheret (www.sharsheret.org) and FORCE (www.facingourrisk.org),” says Bridget Roemmich, MPA, genetics program coordinator of the Oregon Health Authority.

Ashkenazi Jews are more than 10 times as likely as the general population to have a genetic mutation (BRCA1 or BRCA2) that increases their risk of developing breast, ovarian and other cancers (see box).

“We think testing is important because they (Ashkenazi Jews) have a 1 in 40 risk of having a mutation, with or without a family history of breast cancer,” says Dr. Jone E. Sampson, clinical director of OHSU’s Knight Cancer Center. Men can also carry the gene but are less likely to develop breast cancer, so the risk might not show up in family history, she explains.

Sampson says women should have genetic counseling before undergoing the test so they are aware of their options if the test is positive. Options include prophylactic surgery and enhanced screening.

Most health insurance plans now cover genetic counseling, testing, prophylactic surgery and enhanced surveillance, she says.

Many women choose enhanced surveillance of alternating MRIs and mammograms every six months for breast cancer, Sampson says. But she adds that for those with a mutation, “We always recommend women have prophylactic surgery for ovarian cancer at about age 39½.”

She says the cancer center recommends the prophylactic surgery because ovarian cancer is difficult to detect, but recommends waiting until nearly age 40 because it balances the risk for ovarian cancer with the risks associated with premature menopause. The oophorectomy has the added benefit of reducing the lifetime risk for breast cancer by 50%.

This Oregon Public Health Genetics Program outreach project has conducted two trainings with volunteers willing to speak to groups or individuals and is currently working on a social media “mythbusters” campaign with breastcanceranswers.com. The project is funded by a larger grant from the Centers for Disease Control and Prevention to Enhance Oregon Breast Cancer Genomic Practices through Policy, Education and Surveillance.

• In the general population, an estimated 1 in 500 individuals has a BRCA1 or BRCA2 mutation, while 1 in 40 Ashkenazi individuals has one of those mutations.

• When a woman has a mutated copy of the BRCA1 or 2 gene, she has a 25-40% chance of developing ovarian cancer in her lifetime. That means two to four out of every 10 women with the mutation will develop ovarian cancer.

• Women with a mutation on either gene have up to an 80% lifetime risk for breast cancer.

• In 1990 DNA linkage studies on large families with high incidences of breast cancer identified the first gene associated with breast cancer. Scientists named this gene “breast cancer 1” or BRCA1 (pronounced brak-uh). BRCA1 is located on chromosome 17.

• In 1994, scientists discovered another gene and named it BRCA2. BRCA2 is located on chromosome 13.

• Both BRCA1 and BRCA2 are tumor suppressor genes that usually have the job of controlling cell growth and cell death. Everyone has two BRCA1 (one on each chromosome 17) and two BRCA2 genes (one on each chromosome 13). When a person has one altered or mutated copy of either the BRCA1 or BRCA2 gene, his or her risk for various types of cancer increases:

* Up to 80% lifetime risk for breast cancer

* 20-40% lifetime risk for second breast cancer (not reappearance of first tumor)

* 25-40% lifetime risk for ovarian cancer

* 6% lifetime risk for breast cancer in males

* Increased risk for other cancer types, such as pancreatic, prostate, laryngeal and stomach cancer, and melanoma

(Source: OHSU Knight Cancer Center)

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