Movie star Angelina Jolie made headlines — and fueled a national discussion — last week with her announcement that she had a double-mastectomy to prevent breast cancer because she carried a gene associated with the disease.
The genetic test that convinced Jolie she needed the operation has been available in Medford since January at the Leila J. Eisenstein Breast Center at Providence Medford Medical Center.
The test showed that Jolie carried a gene mutation, known as BRCA1 or BRCA2, which indicates an increased chance of developing hereditary breast or ovarian cancer.
Jolie's actions have drawn attention to the preventive measures those who carry the gene can take.
"This is something you can pass to your children," says Kate Newgard, oncology nurse navigator at the breast center at Providence. She notes that both mothers and fathers can be carriers for the gene.
In January, the Medford breast center began offering free risk assessments, which include a questionnaire and a comprehensive look at family medical history, and counseling about options, including genetic testing for the BRCA1 and BRCA2 genes.
Patients up to age 80 who test positive for either of the genes potentially face a risk as high as 87 percent of developing breast cancer, according to Newgard. The chance of developing ovarian cancer is potentially upward of 47 percent. As a patient approaches age 80, the risk decreases, she said.
"What we tell women is that this is a lifetime risk," said Newgard. "That's not today. It's more that the possibility of it happening up to the age of 80 is there."
When the genetic tests first became available, they were used primarily for people who had already had cancer. Local people who wanted to be tested often were referred to genetic counselors in Eugene or Portland, which prompted Providence Medford Medical Center to start its own program.
"There was a real need in the community because we didn't have anyone who was doing the genetic counseling," said Dr. Nancy Hagloch, from the Providence Medical Group OB/GYN Health Center. Hagloch has now been trained to perform the counseling.
Asante Rogue Regional Medical Center also offers free counseling through oncology nurse navigators to help people determine whether they would like to explore the possibility of genetic counseling with Hagloch or another certified genetic counselor in the state.
Before testing, patients fill out a questionnaire examining family history and other risk factors to determine whether they meet the criteria for being a gene carrier, followed by consultation.
People interested in the test should know which of their relatives have had cancer and at what ages those relatives were diagnosed. Questionnaires ask about first- and second-degree family members, and it is important for patients to understand the difference. First-degree family members include mothers, fathers, sisters, brothers and children. Second-degree family members include aunts, uncles, grandparents, nieces and nephews.
"Genes trickle downhill," said Newgard, noting that patients often are concerned about cancer in distant relatives. "It has to be passed from a parent to a parent."
If it is determined that genetic testing would be worthwhile, a blood sample can be drawn the same day. The results take about five weeks, and a follow-up consultation with Hagloch would be scheduled.
If the results come back positive, there are three possible levels of preventive care: increased screening and surveillance, drug treatment or — a last resort — surgery such as a mastectomy or hysterectomy.
Newgard says that while the causes of some cancers are understood, many occur sporadically and remain a mystery. Even if a person has a family member who has had cancer, it may not be caused by genetics.
"You really look for patterns," said Newgard. "But when you sort of see those random cancers, sometimes it's just random cancer."
People who have complicated family medical histories may be referred to other specialists for risk assessment, she noted.
Newgard said testing does not need to happen until a person's late 20s or early 30s. Newgard fears that testing younger patients may cause unnecessary worry.
"All of this is meant to help women and empower them, not to scare them," said Newgard.
She recommends that women who are concerned they may carry the gene examine their family history and potentially pre-screen themselves using resources online.
She suggests an online quiz — on the BRAC Analysis website from Myriad, the company that patented the genetic test — which provides information that medical professionals such as herself use. The quiz can be found at http://tinyurl.com/a9no5tr
Shannon Houston is a Southern Oregon University intern. Reach her at email@example.com.