Breast Cancer: Small Families, Silent Genes

Thousands of women are potentially affected by these policies. The BRCA mutation is responsible for 5 percent of breast cancers and almost 10 percent of ovarian cancers, says Weitzel.

Since there are nearly 270,000 new cases of breast cancer each year, that amounts to almost 13,500 women with breast cancer annually who could benefit from the test if they received it.

Dr. Noah Kauff of Memorial Sloan-Kettering Cancer Center in New York wrote an accompanying editorial to Weitzel's paper, expressing dissatisfaction with the way that computer models and formulas don't do a good job of identifying women who might have BRCA mutations.

He also points out a disconcerting fact; many current cancer patients were diagnosed before BRCA genes were even discovered in the mid-1990s.

"Patients should advocate for themselves," he said. "The oncologist might not go back and do a family history or think about the gene."

Kauff agrees with Weitzel that women without female relatives who develop breast cancer before age 50 should be tested. The 40-50 age group often "falls through the cracks," he said.

"Physicians and patients are good at identifying if there are seven people in the family with ovarian or breast cancer," Kauff said. "What they're not good at is the limited family history which could still be a source [of risk itself]."

For women significantly older, though, the experts agree that the chances of a BRCA mutation having caused a cancer are very low.

Better Family Histories, Increased Detection?

Dr. Mary Daly of Fox Chase Cancer Center, a recognized expert on BRCA genes, said the news could help patients get better care for themselves.

"One in 800 people carries the mutation," she says. "[Patients should] get as thorough a family history as they can from relatives. If they have any suspicions, they should see a genetic counselor to work out the issues.

"My grandparents are both deceased -- I wished I would have asked them more questions when I was younger."

Dr. Marisa Weiss, founder of the Web site Breastcancer.org, said, "This study is important for both sides of the patient-doctor relationship: to make sure that each patient gets the best guidance so she can take appropriate steps to reduce her risk of getting breast cancer again, as well as ovarian cancer."

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