Possible Impacts On Insurance
The Association of British Insurers and the Government have agreed that people do not need to disclose the results of genetic predictive tests for cancer.
Insurance companies can still ask about family history. So if you have had a genetic test and its negative, you may choose to tell the insurance company.
If you have had any problems with an insurance company that you can’t sort out, you can make a complaint to the Financial Ombudsman Service.
Your Insurance Should Cover Breast Cancer Screening
Thanks to the Affordable Care Act, all health insurance plans should cover yearly mammograms with no out-of-pocket costs for women 40 and older. If your doctor says youre at a higher risk of breast cancer because of family history, an inherited gene mutation or other risk factors, your screening should be covered even if youre under 40. CBEs and screening breast MRIs should also be covered if your doctor recommends them. Medicare and Medicaid also cover breast cancer screening. Check with your insurance provider to find out where you should go for screenings and make sure theyll cover whatever services you need.
Breast Cancer Screening For Women With Other High
There are special screening recommendations for women with some other inherited gene mutations linked to breast cancer, including:
- ATM
- PTEN
- TP53
Data on these gene mutations and their related breast cancer risks are still emerging and will likely change over time as more is learned.
A womans personal risk factors and family history of cancer also impact breast cancer screening recommendations.
Learn more about the cancer risks related to these inherited gene mutations.
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How Common Are Breast Cancer Gene Mutations
Breast cancer gene mutations arent common in the general population, Dr. Eng says, but they are common in people who have breast cancer. About 10% to 15% of people with breast cancer have one of the breast cancer gene mutations.
You can inherit these gene mutations from either of your biological parents, and the cancers theyre linked to can affect both men and women so consider all your relatives when thinking about your family history.
What If I Dont Have A Strong Family History
After looking at your family history, the genetic doctor might tell you that its unlikely that you have an inherited faulty gene. In this case, your risk of cancer is the same as other members of the population.
In certain situations, the genetic counsellor might suggest you have regular screening. This is more likely if members of your family have breast or bowel cancer.
You can find out about this in our information about:
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Genetic Testing For Hereditary Breast And Ovarian Cancer
Genetic testing is available for hereditary breast and ovarian cancer. Most breast and ovarian cancer is not caused by inherited mutations, so genetic testing will not help most women with a family health history of breast and ovarian cancer. Genetic testing will not identify the cause for some hereditary breast and ovarian cancers, because the genes affected in these cancers are not yet known.
Genetic counseling before genetic testing for hereditary breast and ovarian cancer is important to determine whether you and your family are likely enough to have a mutation that it is worth getting tested. Usually, genetic testing is recommended if you have:
- A strong family health history of breast and ovarian cancer
- A moderate family health history of breast and ovarian cancer and are of Ashkenazi Jewish or Eastern European ancestry
- A personal history of breast cancer and meet certain criteria
- A personal history of ovarian, fallopian tube, or primary peritoneal cancer
- A known BRCA1, BRCA2, or other inherited mutation in your family
The BRCA1 and BRCA2 genes
Genetic counseling after genetic testing is important to help you understand your test results and decide the next steps for you and your family:
How To Get Brca Genetic Testing
Genetic counseling is recommended for those who are interested in being tested for breast cancer gene mutations. You can talk to a doctor about getting a referral to a genetic counselor, who can help determine whether genetic testing would make sense based on family history and risk factors. Since many genetic tests only look for one specific gene mutation, the counselor can often help determine which mutations to test for.
The genetic test itself simply involves taking a small sample of blood or saliva, which is sent to a lab for analysis. Results can take several weeks or months.
Genetic testing results are not always clear-cut:
- A test result can be positive, meaning that the patient does carry the gene mutation.
- A negative test result indicates that they do not have that particular known gene mutation. It does not, however, rule out the possibility of having mutations in other genes. It also does not rule out the possibility of developing breast cancer. Most breast cancer cases are not hereditary, so everyone should still have an early detection plan.
- Genetic test results can also be uncertain or ambiguous. An ambiguous test result means that a mutation has been found on the gene, but it is not yet known whether that particular mutation has any effect on the chances of developing breast cancer.
- Someone is either negative or positive. Over time, a person cannot go from being negative to being positive or vice versa for the specific gene mutations they were tested for.
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What Are The Symptoms Of Breast Cancer
Breast pain can be a symptom of cancer. If you have any symptoms that worry you, be sure to see your doctor right away.
Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.
Some warning signs of breast cancer are
- New lump in the breast or underarm .
- Thickening or swelling of part of the breast.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area or the breast.
- Pulling in of the nipple or pain in the nipple area.
- Nipple discharge other than breast milk, including blood.
- Any change in the size or the shape of the breast.
- Pain in any area of the breast.
Keep in mind that these symptoms can happen with other conditions that are not cancer.
If you have any signs or symptoms that worry you, be sure to see your doctor right away.
Why Do Some People Decide Not To Have The Test
After looking at the advantages and disadvantages of testing, some people choose not to have a genetic test. They may feel that they dont want to know if they have a higher than normal cancer risk.
Some people decide they dont want any preventative treatment even if they have a faulty gene. So they may not feel they have anything to gain by having the test.
Only you can decide what is best for you.
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Genetic Counseling And Genetic Testing
Genetic testing gives people the chance to learn if their breast cancer or family history of breast cancer is due to an inherited gene mutation.
This section provides information on genetic counseling and the benefits and risks of testing for inherited gene mutations that increase breast cancer risk. It also has information on direct-to-consumer genetic testing, testing for multiple high-risk gene mutations and other related topics.
Does Insurance Pay For Genetic Testing For Breast Cancer
Insurance pays for genetic testing for breast cancer as long as the person meets the criteria. This includes having a family history of breast cancer or a family history of cancer, such as pancreatic cancer or ovarian cancer. While oncology costs are much more expensive than gene testing by most laboratories in the United States, insurance companies are often charged a lot of money for the test, which is why they are strict with insurance coverage.
Higher risk individuals such as those of Ashkenazi Jewish descent, history or breast cancer, or history of ovarian cancer often receive coverage for breast cancer genetic testing. These risk factors increase their susceptibility to a cancer diagnosis.
Health insurance doesnt always cover 100% of the cost of a DNA test. A co-pay may be required, which is usually a percentage of the total cost. Every health insurance provider has its own costs for breast cancer genetic testing and policies differ greatly.
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How The Testing Works
If youre interested in getting genetic testing, your primary care doctor can refer you to a genetic counselor, or you can find a counselor yourself. The CDC recommends genetic counseling first to help you determine your level of risk and the best testing strategy.
Genetic testing is done with a blood test or saliva sample, and saliva or cheek swab tests can be mailed right to your home if thats easier for you, Larsen Haidle says.
Keep in mind that tests ordered by a doctor or genetic counselor are typically more complete than the direct-to-consumer tests from companies such as 23andMe, which look only for three specific BRCA variants, Larsen Haidle and Pal say.
Private insurance companies and Medicare cover the cost of genetic testing if you meet specific criteria, which vary based on the provider. Even if you dont qualify under your insurers rules, the cost of a genetic test has dropped significantly over the past decade, Larsen Haidle says, with some labs offering quality versions for about $250 out of pocket.
Once you get your results, its important to talk them over with a geneticist, genetic counselor or physician who is knowledgeable about genetics. They can help you interpret the report and better understand any increased risk.
We dont understand why some people do and some people dont, he says. There could be other genes, environmental factors or maybe just luck.
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If You Have Breast Implants
Mammograms are safe and effective for women with implants, but it may be harder to read the results. If you can, find a mammography center where the technologists and radiologists have experience doing mammograms for women with breast implants. Let your technologist know you have implants before your exam. They can position the machine and your breast to get the best image of your natural tissue. Four views of each breast will be taken .
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What Is My Risk Of Developing Breast Cancer
All women in the US, regardless of family history, have a minimum 1:8 or 12.5% risk of developing breast cancer in their lifetime.
Of those that do, 5-10% are considered to be heritable, or strongly related to inheriting a known harmful genetic mutation in a breast cancer predisposition gene. 15-20% are considered to be familial, or family history shows multiple affected family members in multiple generations, but genetic testing is negative for a known breast cancer associated genetic mutation. Meanwhile, 75-80% are considered sporadic, or most likely due to a combination of many factors non-modifiable and modifiable.
If you have many of the non-modifiable and modifiable risk factors discussed in my previous blog post, your risk is likely more than 12.5%.
Will My Children Inherit The Gene
If you have children, there is a 50% chance that they have inherited the altered gene. If you are planning to have children there is a 50% chance they will inherit the altered gene. The risk is the same for boys and girls.
People need to be 18 before any further assessment of their risk of breast cancer can take place.
Find out more about being worried about passing on the gene to future children.
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Referral To A Specialist
Your GP will refer you to a specialist breast clinic or genetics clinic for assessment if you have any of the following:
- one first degree female relative diagnosed with breast cancer aged younger than 40
- one first degree male relative diagnosed with breast cancer at any age
- one first degree relative with cancer in both breasts where the first cancer was diagnosed aged younger than 50
- two first degree relatives, or one first degree and one second degree relative, diagnosed with breast cancer at any age
- one first degree or second degree relative diagnosed with breast cancer at any age and one first degree or second degree relative diagnosed with ovarian cancer at any age
- three first degree or second degree relatives diagnosed with breast cancer at any age
Your GP should also refer you if you have one first degree or second degree relative diagnosed with breast cancer when they were older than 40 years and one of the following:
- the cancer was in both breasts
- the cancer was in a man
- ovarian cancer
- Jewish ancestry
- sarcoma in a relative younger than age 45 years
- a type of brain tumour called glioma or childhood adrenal cortical carcinomas
- complicated patterns of multiple cancers diagnosed at a young age
- two or more relatives with breast cancer on your father’s side of the family
How Genetic Testing Is Done
Genetic testing can be done on samples of blood or saliva, or from a swab of the inside of a cheek. The samples are sent to a lab for testing.
There are many different possible mutations in the BRCA genes. Testing can look for one specific mutation, or more extensive testing can be done to look for many different BRCA mutations. For example, if someone is being tested because they have a family member with a known BRCA mutation, testing might focus only on that specific mutation. In people of Ashkenazi Jewish descent, testing might focus on the specific BRCA mutations that are most common in this group of people. But if theres no reason to suspect a specific gene change, testing will likely look for many different BRCA mutations. Depending on the situation, testing might be done to look for changes in other genes as well.
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Risks Of The Brca Gene Test
To date, there is no known type of risk that is linked to the analysis of the mutation of a BRCA gene , except for the minor ones that can occur when taking blood, such as bruising or dizziness. Likewise, there are economic, emotional, social and medical consequences after knowing the results . Thus, in the case of testing positive, the risks that any person faces can be the following:
- Concern about whether insurance refuses to face your responsibility
- Feelings of sadness, anxiety, anger, and depression
- Tension between members of the same family to know the general situation of each of them regarding the BRCA gene
- Panic thinking you are going to get cancer
- Difficult decisions when taking preventive measures
Also, when the BRCA gene test is negative, or if it is not clear, the following may happen:
- Worry and uncertainty when thinking that perhaps the result is not really negative
- Survivor syndrome in the event that family members do have a known genetic mutation
You can always bet on psychological support in these cases in order to accept the result and look to the future with greater stability and greater strength.
Consider Your Personal And Family History
Not everyone who has had breast cancer or who has a relative with breast cancer needs to have a breast cancer genetic test.
You may be a candidate for genetic testing for BRCA mutations if any of your relatives know they carry a mutation. Or if you, or any of your first degree relativesparents, siblings, and childrenhave any of the following:
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A diagnosis of breast cancer at age 50 or earlier.
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Triple negative breast cancer at age 60 or earlier.
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More than one case of breast cancer or cancer in both breasts.
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For those of Ashkenazi Jewish heritage, breast or ovarian cancer at any age.
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A diagnosis of ovarian cancer.
If you have been diagnosed with breast, ovarian or pancreatic cancer, and two other relatives on the same side of your family also have one of those cancers , it may also be a sign that youre a candidate for BRCA testing.
Finding out you have a genetic mutation can help your other family members decide if they should get tested, because they may be at higher risk. And even if you already have cancer, knowing your BRCA mutation status can inform the decisions you make about treatment. For instance, a woman with breast cancer and a BRCA mutation may consider removing her ovaries, to reduce the risk of ovarian cancer.
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Having Radiation To Your Chest
Women who were treated with radiation therapy to the chest for another cancer when they were younger have a significantly higher risk for breast cancer. This risk depends on their age when they got radiation. The risk is highest for women who had radiation as a teen or young adult, when the breasts were still developing. Radiation treatment in older women does not seem to increase breast cancer risk.
What Are Brca1 And Brca2
BRCA1 and BRCA2 are genes that produce proteins that help repair damaged DNA. Everyone has two copies of each of these genesone copy inherited from each parent. BRCA1 and BRCA2 are sometimes called tumor suppressor genes because when they have certain changes, called harmful variants , cancer can develop.
People who inherit harmful variants in one of these genes have increased risks of several cancersmost notably breast and ovarian cancer, but also several additional types of cancer. People who have inherited a harmful variant in BRCA1 and BRCA2 also tend to develop cancer at younger ages than people who do not have such a variant.
A harmful variant in BRCA1 or BRCA2 can be inherited from either parent. Each child of a parent who carries any mutation in one of these genes has a 50% chance of inheriting the mutation. Inherited mutationsalso called germline mutations or variantsare present from birth in all cells in the body.
Even if someone has inherited a harmful variant in BRCA1 or BRCA2 from one parent, they would have inherited a normal copy of that gene from the other parent . But the normal copy can be lost or change in some cells in the body during that persons lifetime. Such a change is called a somatic alteration. Cells that dont have any functioning BRCA1 or BRCA2 proteins can grow out of control and become cancer.
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