Genetic Testing for BRCA1 and BRCA2, Part 3

by National Cancer Institute

(Page 3 of 3)

A person who tests positive for a BRCA1 or BRCA2 alteration may also experience genetic discrimination in the workplace if an employer learns about the test result. Although there are currently no Federal laws specific to genetic nondiscrimination, some protection from discrimination by employers is offered through the Americans with Disabilities Act of 1990 (ADA). In 1995, the Equal Employment Opportunity Commission (EEOC) expanded the definition of "disabled" to include individuals who carry genes that put them at higher risk for genetic disorders. The extent of this protection, however, has not yet been tested in the courts.

Several states also have laws that address genetic discrimination by employers and health insurance companies. The degree of discrimination protection varies from state to state. Therefore, the decisions that people make about genetic testing while living in one state may have repercussions in the future if they move to another area.

How are the tests for BRCA1 or BRCA2 performed?

Testing for alterations in a person's BRCA1 or BRCA2 gene is done on a blood sample. The person's blood is drawn in a laboratory, doctor's office, hospital, or clinic, and the blood sample is sent to a laboratory to check for alterations in the BRCA1 and/or BRCA2 genes.

How much does testing cost and how long does it take to get the results?

The cost for genetic testing can range from several hundred to several thousand dollars. Insurance policies vary with regard to whether the cost of genetic testing is covered.

As addressed above, because the results of genetic tests can affect a person's health insurance coverage, some individuals may not want to use their insurance to pay for testing. Some people may choose to pay out-of-pocket for the test, even when their insurer would be willing to cover the cost. To protect their privacy, some may not even want their insurer to know they are thinking about genetic testing. Others may decide to ask their insurance company to cover these costs. People who are considering genetic testing may want to find out more about their particular insurance company's policies and the privacy protection laws in their state before submitting the charge for the test.

From the date that blood is drawn, it can take several weeks or months for test results to become available. The length of time depends on the tests performed and other factors. Individuals who decide to get tested should check with their doctor or genetic counselor to find out when test results might be available.

What factors increase the chance of developing breast and/or ovarian cancer?

The following factors have been associated with increased breast and/or ovarian cancer risk. It is not yet known exactly how these factors influence risk in people with BRCA1 or BRCA2 alterations.

Age — The risk of breast and ovarian cancers increases with age. Most breast and ovarian cancers occur in women over the age of 50. Women with an altered BRCA1 or BRCA2 gene often develop breast or ovarian cancer before age 50.

Family History — Women who have a first-degree relative (mother, sister, or daughter) or other close relative with breast and/or ovarian cancer may be at increased risk for developing these cancers. In addition, women with relatives who have had colon cancer are at increased risk of developing ovarian cancer.

Medical History — Women who have already had breast cancer are at increased risk of developing breast cancer again, or of developing ovarian cancer. Women who have had colon cancer also have an increased risk of developing ovarian cancer.

Hormonal Influences — Estrogen is naturally produced by the body and stimulates the normal growth of breast tissue. It is suspected that excess estrogen may contribute to breast cancer risk because of its natural role in stimulating breast cell growth. Women who had their first menstrual period before the age of 12 or experienced menopause after age 55 have a slightly increased risk of breast cancer, as do women who had their first child after age 30. Each of these factors increases the amount of time a woman's body is exposed to estrogen. Removal of a woman's ovaries, which produce estrogen, reduces the risk of breast cancer.

Birth Control Pills (Oral Contraceptives) — Most studies show a slight increase or no change in breast cancer risk in women taking birth control pills. Some studies suggest that a woman who has taken birth control pills for a long period of time, and began taking them at an early age or before her first pregnancy, has a small increase in her risk for developing breast cancer. In contrast, taking birth control pills may decrease a woman's risk of ovarian cancer.

Hormone Replacement Therapy — A woman's risk for developing breast cancer may be increased by hormone replacement therapy (HRT), especially when it is used for a long period of time. Doctors may prescribe HRT to reduce the discomfort from symptoms of menopause, such as hot flashes. Some evidence suggests that women who use HRT after menopause may also have a slightly increased risk of developing ovarian cancer. HRT may have positive health effects as well, such as lowering a woman's risk of heart disease and osteoporosis. These protective effects diminish after a woman discontinues therapy. The risks and benefits of HRT should be carefully considered by a woman and her health care provider.

Dietary Fat — Although early studies suggested a possible association between a high-fat diet and increased breast cancer risk, more recent studies have been inconclusive. It is not yet known whether a diet low in fat will lower breast cancer risk.

Physical Activity — Studies of the relationship between physical activity and breast cancer have had mixed results. However, some studies suggest that regular exercise, particularly in women age 40 and younger, may decrease breast cancer risk.

Alcohol — Alcohol use may increase breast cancer risk, but no biological mechanism for the relationship between alcohol and breast cancer risk has been established.

Environmental Factors — Exposure of the breast to ionizing radiation, such as radiation therapy for Hodgkin's disease or other disorders, is associated with an increased risk of breast cancer, especially when the exposure occurred at a young age. Evidence for the effect of occupational, environmental, or chemical exposures on breast cancer risk is limited. For example, there is some evidence to suggest that organochlorine residues in the environment, such as those from insecticides, might be associated with an increase in breast cancer risk. However, the significance of this evidence has been debated. Scientific research is currently in progress to study the effects of various environmental factors on breast cancer risk.

Where can people get more information about genetic testing for cancer risk?

A person who is considering genetic testing should speak with a professional trained in genetics before deciding whether to be tested. These professionals may include doctors, genetic counselors, and other health care workers trained in genetics (such as nurses, psychologists, or social workers). For more information on genetic testing or for help finding a health care professional trained in genetics, contact the National Cancer Institute's Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237) (see below). The CIS can also provide information about clinical trials (research studies with people) and answer questions about cancer.

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