Q: What is hereditary cancer?
A: Cancer is a common disease so most families will have some members who have had cancer. Hereditary cancer occurs when a person is born with mutations in certain genes which normally protect against cancer. These mutations can be passed down from one generation to the next and, importantly, can come from either side of the family. You may have heard of BRCA1 or BRCA2. These are the most common genes known to be associated with hereditary breast and ovarian cancer. Other gene mutations have been identified but are not as well studied and others are yet to be identified. It is important to remember that not everyone born with a gene mutation will develop cancer.
Q: What family health history do I need to collect?
A: There are three simple questions that can help you determine whether there is a risk of hereditary cancer in your family:
1. Have any of your blood relatives had cancer?
2. What types of cancer were they?
3. How old were they when they developed cancer?
For further details on what to collect, a mapping template and tips for talking to your family see Pink Hope’s Kiss and Tell resources.
Q: How do I see a Genetic Counsellor?
A: After researching and documenting your family health history you may find it helpful to complete the Pink Hope Assess Your Risk tool. You can then discuss these results with your GP. If you and your GP have concerns about your level of cancer risk your GP can refer you to see a Genetic Counsellor at a Family Cancer Clinic which is covered by Medicare and Family Cancer Clinics are located throughout Australia. You can also submit questions to the Pink Hope Online Genetic Counsellor to help you identify and manage your risk.
Q: What cancer risks are there for men with BRCA mutations?
A: Men have breast tissue and BRCA genes and can inherit mutations that put them at greater risk for cancers. Although only 1% of all breast cancers develop in men, having a BRCA mutation means increased risk, particularly for men with BRCA2 (who face a 6% lifetime risk). BRCA mutations (especially BRCA2 mutations) also raise a man’s chance of developing prostate cancer that develops at an earlier age than men who do not have a mutation. It also tends to be more aggressive, so early diagnosis is even more important.
Q: Could I have inherited the BRCA gene fault from my father?
A: Yes. Both women and men can carry the defective gene. They also have a 50/50 chance of passing it on to their child.
Q: I am a man, should I get testing? Should my dad get testing?
A: Men from families with a history of breast and ovarian cancer should consider testing for a BRCA gene mutation particularly if any of the breast cancers occurred before age 50 (in either female or male relatives). Men with breast cancer themselves are highly likely to have a BRCA mutation and should consider testing. Men who have prostate cancer and a family history of breast cancer should also think about testing.
The publication Understanding genetic tests for men with a family history of breast and ovarian cancer is available through the Centre for Genetics Education.
Q: What are the costs involved with genetic testing?
A: If a genetic fault has already been found in your family:
- Free genetic testing for the family genetic fault is available to you. You will need to be referred by your doctor to a local familial cancer service.
- You will then need to provide the service with the name of your relative tested, and where they were tested.
- In many cases, your relative will have given you a Family Letter from their clinic which contains this information.
If a genetic fault has not been found in your family. Some families may qualify for publicly funded (free) genetic testing. Genetic testing of the BRCA1 and BRCA2 genes may be offered for free if:
- There is a strong family history of breast or ovarian cancer (at least a 10% chance of having a faulty BRCA1/2 gene in the family, as assessed by a genetic counsellor however, this will depend on the department you are referred to as some departments use a criteria of at least 15% chance of identifying a mutation)
- A relative who has had breast or ovarian cancer themselves is willing to have the testing.
Publicly funded genetic testing is only available through a Family Cancer Clinic
. Your family doctor cannot order genetic testing for BRCA1 or BRCA2.
Your genetic counsellor will work out whether you qualify for free testing. If your family does not qualify, the test can still be done if you elect to pay for it. The price is approximately $2000. The cost of the test is not covered by Medicare or by private health insurance.
Q: I am a man with a BRCA mutation, what can I do to reduce my risk?
A: Men who know they carry a BRCA gene mutation can take proactive steps such as getting screened regularly for some of the cancers associated with the mutation, such as prostate cancer screening, skin examinations for melanoma. Men with a BRCA mutation should also seek medical advice about any changes in their breasts.
The Centre for Genetics Education has information on prostate cancer screening - Prostate Cancer Screening: Decisions for men with a family history of prostate cancer.
It is important to share your BRCA result with your family, when it is appropriate, as it may be life saving information for your sisters, mother and daughters.