Those of us who live in the New Tampa area are fortunate to live so close to one of the country’s leading cancer research and treatment centers — the H. Lee Moffitt Cancer Center & Research Institute — which is located just a few miles to the south, on the University of South Florida (USF)’s Tampa campus.
Moffitt belongs to an elite group of cancer centers that has achieved distinction from the National Cancer Institute (NCI). As the only NCI-designated Comprehensive Cancer Center based in Florida, the outstanding doctors and staff at Moffitt work tirelessly in the areas of patient care, research and education — developing early-stage translational research aimed at the rapid translation of scientific discoveries to benefit patients.
Today, almost 30 years after first opening its doors, Moffitt is considered to be one of the fastest-growing cancer centers in the U.S.. The center provides a level of care that stands above the rest, with a team of experts that provides a plan that’s right for you, right from the start, resulting in shorter treatment times, reduced hospital stays and improved quality of life during and after cancer treatment.
For you, that means better outcomes, and your best chance for beating cancer.
However, detecting and diagnosing the deadly disease is the first step.
Genetics & Cancer
Hair color, facial features, height and complexion are just a few of the many inherited traits that link one generation of a family to the next. Some family trees also happen to include hereditary genetic mutations that raise the risk for getting many forms of cancer. While hereditary is a real concern and can increase one’s risk of developing cancer, most cancer patients still have no clear hereditary component to their cancers.
However, according to the National Cancer Institute (NCI), a small portion of malignancies — approximately 5-10 percent — occur as a result of a genetic predisposition.
Breast and ovarian cancers are two diseases that have been linked to hereditary gene mutations, NCI reports. The mutation occurs at BRCA1 and BRCA2, also known as the “breast cancer susceptibility genes.” BRCA1 and BRCA2 are “tumor suppressor genes” that have the job of controlling cell growth and cell death. Everyone has two BRCA1 and two BRCA2 genes. When one of those altered or mutated copy of either the BRCA1 or BRCA2 gene, your risk for developing breast or ovarian cancer increases.
NCI studies have determined that an average woman’s lifetime risk for breast cancer is about 12 percent. In women who have inherited a BRCA gene mutation, that risk is greatly increased, to as much as 60-70 percent.
BRCA-associated breast cancers tend to develop at a younger age. The mutation also substantially raises the risk of ovarian cancer in women. The general population risk for ovarian cancer is less than 2 percent, as compared with a woman with a BRCA mutation, whose risk is as much as 44 percent. And, NCI reports that it’s not just women who have health implications of a BRCA gene mutation. In fact, men who inherit the BRCA gene mutations – especially BRCA2 – are more prone to both breast cancer and prostate cancer. Men also can pass this mutation on to their children.
Having a BRCA mutation does not mean someone will have cancer or even that they will develop cancer in the future. It simply means that because of alterations to their DNA, their chance of developing certain cancers is greater than that of the average person. Learning about your personal risk will allow you to make more informed decisions about prevention measures and create a personalized medical management plan.
The following features make inherited cancer risk more likely within a family:
• Two or more people, on the same side of the family, who have had the same type of cancer
• Cancer diagnosed at age 50 or younger
• Cancer in paired organs (e.g. both breasts, both eyes, etc.)
• The presence of a very rare cancer (e.g., male breast cancer)
• A family member with more than one type of cancer (e.g., both colon and uterine cancer OR both breast and ovarian cancer)
• Cancer in two or more generations of the family
• Ethnic background (for example, BRCA mutations are more common in those of Ashkenazi Jewish ancestry)
Women who carry the BRCA1 or BRCA2 gene mutations can take precautions to help lower their cancer risk. A new study published earlier this year in the Journal of Clinical Oncology (JCO) shows that women with BRCA1 and BRCA2 gene mutations who had preventive ovarian surgery, known as a prophylactic oophorectomy, reduced their risk of ovarian, fallopian tube, or peritoneal cancer by 80 percent and their overall risk of death by 77 percent.
“This is a massive reduction,” says Moffitt Medical Group president Jonathan Lancaster, M.D., Ph.D. “The implications are significant for women who have very high risk for ovarian cancer. Unfortunately, we know ovarian cancer for many women is a death sentence. The ability to identify a woman based on the inheritance of a gene who may be able to have that disease avoided — to be able to prevent that disease — really is an advance.”
According to the JCO study, women with BRCA1 mutations should have their ovaries removed by the age of 35, as waiting appears to increase the risk of ovarian cancer by about 4 percent, and can rise to more than 14 percent if a woman waits until age 50. In contrast, the study notes women with BRCA2 mutations can safely delay surgery until their 40s, as their risk of ovarian cancer is not as strong.
“This is the largest study to date that confirms that women who carry BRCA1 and BRCA2 mutations should really consider reducing their cancer risk by having a bilateral prophylactic oophorectomy,” Lancaster explains. “For women who are concerned about their hereditary risks, we advise they speak with their primary care physician, Ob/Gyn or seek counseling from a professional with genetic expertise, such as a genetic counselor.”
Genetic Testing At Moffitt
Moffitt’s Genetic Risk Assessment Service offers such genetic counseling, as well as screening and testing for people who may be at an increased risk for cancer. By identifying high-risk families, a Moffitt genetic counselor can help individuals understand their risk for developing all types of cancer, as well as their options for prevention, early detection and treatment.
Genetic counseling is a form of education and risk assessment. Individuals having genetic counseling learn about their specific risk factors based upon reported information; although having genetic counseling does not mean that a person must proceed with genetic testing. Many people who have genetic counseling do not have genetic testing.
Genetic testing in a cancer setting involves specific analysis of blood to look for an inherited gene change that is linked with an increased risk to develop cancer. For example, genetic tests can check for BRCA1 and BRCA2 mutations in individuals with a personal and/or family history of cancer that suggests the possibility of mutation in one of these genes. If a BRCA1 or BRCA2 mutation is found as a result of genetic testing, several options are available to help a person manage their cancer risk. The selection of which prevention or treatment options to pursue is a personal decision that should be made between the patient and his or her health care provider.
At Moffitt, the genetic counselor will review your personal and family cancer history, including the type or types of cancer, your age and the age(s) of family members at the time of diagnosis. The genetic counselor will discuss the risks, benefits and limitations of testing, the emotional implications, confidentiality issues and insurance coverage. This discussion will help you decide if genetic testing is right for you.
If you would like to schedule an appointment with Moffitt’s Genetic Risk Assessment Service, call 1-888-MOFFITT (663-3477). For more info, please visit Moffitt.org.
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