VA NY Harbor Health Care System
Genetics counseling at VA
Tuesday, June 11, 2013Recent media coverage of actress Angelina Jolie's decision to have a double mastectomy after learning she was genetically at high risk for breast cancer has gotten national attention. Surgery to reduce her chances of having cancer has raised concerns among many women of both Ashkenazi and non-Ashkenazi decent, especially those who have close relatives with gynecologic cancers.
Among the Ashkenazi Jewish community - those of Eastern European decent - questions about the impact of carrying the BRCA1 and BRCA2 gene mutations, talk of taking preventive surgical measures have been the buzz for some time. "Women with this background are likely to be particularly self-aware since the gene is more frequent amongst this particular population," said Dr. Michael Abrahams, a gynecologist at VA New York Harbor Healthcare System's Brooklyn Campus. "By contrast, because African American women carry the gene mutation less often, they request screening and are tested less often, and are therefore more likely to be surprised."
An interest in pursuing further questions about her predisposition to getting cancer or having a recurring cancer usually depends on a woman's personality, knowledge of her family history and support network. The discussion should start in her gynecologist's or primary care provider's office, according to Rebecca Hulinsky, Genetics Counselor, at VA's Centralized Genetics Counseling Service based in Salt Lake City, Utah. Hulinsky said following a care provider's recommendation, a Veteran would be referred to the genetics center where a counseling session can be set up through virtual (CVT) technology. “We do cancer risk assessment to see if there is an inherited disposition to cancer.” She explained that the basis of risk often goes beyond having a BRCA mutation gene and includes other factors, such as family history of cancer, a past exposure to radiation, hormones or lifestyle issues, such as alcohol abuse.
Following the session with one of the eight genetics counselors at the genetics center, a test for BRCA1 and BRCA2 gene mutation may be recommended. It is an analysis of a blood sample sent to Myriad, the company that holds a world-wide patent on the testing.
Dr. Abrahams explained that these mutations are flaws in the reparative process of a cell. If a cell doesn't have the mechanism to repair, it may proceed to grow out of control — a simple explanation of what cancer is. Dr. Abrahams said that women who choose to be tested for BRCA1 or BRCA2 genes should understand that a positive result "does not mean that they will all get cancer. It is only that their chances are elevated."
Dr. Abrahams said that women Veterans who have tested positive and have opted for mastectomies and breast reconstruction are referred to the breast surgeon at VA’s Brooklyn Campus. He noted that breast reconstruction is usually so skillfully done that it is minimally noticeable. Regarding the removal of ovaries and the uterus, Dr. Abrahams suggests that if some women prefer not to have ovaries removed to avoid possible early menopause, "there is some evidence that at least removal of the fallopian tubes would reduce the risk of cancer."
Hulinsky said VA is strongly supportive of genetic testing and is already providing counseling to 40 VA’s with more on the horizon.