MEDICINE&SCIENCE
Baltimoresun.com/marylandhealth
there is a genetic component when often there is not. For example, cancer that develops in a great-aunt in her senior years is likely the result of age and perhaps lifestyle and environment, and is not likely to be a sign of increased risk among relatives.
Cancer that develops in a sister or mother when she is young is more of a red flag, Scott said.
“I can say who needs to be tested,” said Scott. “And as testing gets better, one test can look at many genes. I can cast a wide net.”
Scott and Dr. Kala Visvanathan, who leads the high-risk program in the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, say insurance often covers the tests, which range in cost but can exceed $3,000. They also said more kinds of tests are becoming available as additional associations between genes and cancer become known.
Visvanathan, a medical oncologist and researcher focused on breast and ovarian cancer, said it’s important for doctors and patients to be aware that there are genetic counselors and centers dedicated to understanding who can benefit. That could prevent more cancers in individual or their families, she said.
“My concern is that individuals and medical providers are not realizing there are these services and they can reach out,” she said. “Not everyone who should be tested is getting tested.”
One problem, Visvanathan said, is that there are parts of the country without full centers, staffed with genetic counselors and a range of specialists to address different types of cancers. She was unaware of anyone who tracks the centers, but said they are not easy to form because they require specific expertise.
Another issue is countering fear of cancer, and publicity from celebrities such as actress Angelina Jolie, who has a BRCA mutation and had a preventive double mastectomy in 2013 and had her ovaries removed two years later. A study last year found her actions spurred more women to seek genetic testing, but because there wasn’t a corresponding rise in mastectomies, researchers concluded that these were not women who actually had mutations.
Another recent study also showed that women with cancer in one breast were opting for double mastectomies despite a lack of evidence that it increases odds of survival.
The study published last month in JAMA Surgery found in the decade ending in 2012 that the proportion of patients who underwent double mastectomies increased to 10.4 percent from 3.6 percent among women 45 and older. It increased to 33.3 percent from 10.5 percent among women ages 20 to 44. It wasn’t clear how many had troubling indicators, such as Jolie’s mutation or Dressel’s family history.
“Surgeons and other health care professionals should educate their patients about the benefit, harm and cost ... to help patients make informed decisions about their treatments,” said Dr. Ahmedin Jemal, a senior author on the study and vice president of surveillance and health services research at the American Cancer Society.
Ottaviano said the MedStar program, which opened at the end of April, aims to give patients as much information as possible to make good choices, including preventive treatments
“There are tools and guidelines,” Ottaviano said about who should be evaluated. “This is really about education.”