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Genetic Counseling for Hereditary Breast and Ovarian Cancer

The BRCA1 and BRCA2 genes

The breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes are the genes most commonly affected in hereditary breast and ovarian cancer. Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. But certain mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast, ovarian, and other cancers. You and your family members are more likely to have a BRCA1 or BRCA2 mutation if your family has a strong history of breast or ovarian cancer. Because BRCA1 and BRCA2 mutations are inherited, family members with BRCA1 or BRCA2 mutations usually share the same mutation.

If you have a personal or family health history of breast or ovarian cancer that indicates that you could have a BRCA1, BRCA2, or other inherited mutation, your doctor may refer you for genetic counseling. Understanding and dealing with a strong family health history of breast or ovarian cancer can be challenging for you and your family. Genetic counselors can help by providing information, resources, and support to you and your family.

Genetic counseling can help you and your family make informed decisions about genetic testing for BRCA1, BRCA2, and other inherited mutations. A genetic counselor or other health care provider with specialty training in cancer genetics can provide genetic counseling.

If you do not have a personal history of breast or ovarian cancer

  • BRCA genetic counseling, if appropriate, is covered without cost sharing by many health plans under the Affordable Care Act when used in accordance with the USPSTF recommendation.
    • The Department of Health and Human Services has advised insurance companies to also cover the BRCA test without cost sharing in accordance with the USPSTF recommendation.

If you have a personal history of ovarian cancer

  • Genetic counseling and testing is often, but not always, covered by insurance.

If you have a personal history of breast or other cancers

  • Genetic counseling and testing might be covered by insurance, depending on
    • age of diagnosis,
    • type of breast cancer,
    • presence of certain other cancers or cancer in both breasts,
    • ancestry, and
    • family health history of breast, ovarian, and other cancers.

The genetic counselor or other health care provider will collect a detailed medical and family health history. Genetic counseling can provide answers to questions like the following:

  • Do you have an increased risk for breast, ovarian, or other cancers because of your personal or family health history?
  • What are the BRCA1 and BRCA2 genes and how do they relate to cancer?
  • Could the breast, ovarian, or other cancers that run in your family be due to mutations in genes other than BRCA1 and BRCA2?
  • What is the chance that you have a BRCA1, BRCA2, or other inherited mutation?
  • If you have a BRCA1, BRCA2, or other inherited mutation, what is the chance you will get breast or ovarian cancer?
  • How will the results of genetic testing for hereditary breast and ovarian cancer affect your family members?
  • Who in your family should be the first to have genetic testing for hereditary breast and ovarian cancer?
  • How accurate is genetic testing for hereditary breast and ovarian cancer?
  • What are the possible results of genetic testing for hereditary breast and ovarian cancer and what do they mean?
  • What are the potential risks and limitations of genetic testing for hereditary breast and ovarian cancer?
  • How will knowing if you carry a BRCA1, BRCA2, or other inherited mutation help you to lower your risks for cancer?
  • If you have already had breast or ovarian cancer, how will knowing if you carry a BRCA1, BRCA2, or other inherited mutation affect your treatment plan?
  • If you have already had breast or ovarian cancer, what are the chances that you will get cancer again?

Following the genetic counseling session, you may decide you don’t want genetic testing or that it is unlikely to be helpful for you or your family. Most cases of breast and ovarian cancer are not caused by inherited mutations, so genetic testing will not help most women with a family health history of breast and ovarian cancer. Also, genetic testing will not find causes for all hereditary breast and ovarian cancers.

If you decide to have genetic testing for hereditary breast or ovarian cancer, additional genetic counseling following the testing can help you better understand the meaning of your test results.

Learn more about genetic testing for hereditary breast and ovarian cancer.

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