Breast Cancer: Why and When We Recommend Genetic Counseling


January 9th, 2023

Breast Cancer: Why and When We Recommend Genetic Counseling

While October is Breast Cancer Awareness Month, promoting the importance of screenings and when necessary, genetic counseling, is a year-round effort. Most women are aware that their risk of breast cancer increases with age, however, they may not know how their family history may put them at a higher risk of developing certain cancers. Around 10% of breast cancer develops through inherited alterations to certain genes. These alterations cause cancer to appear at a younger age or occur more often. Family history of breast cancer may elevate personal risk, which is why genetic counseling can begin in early adulthood for some individuals.

What’s in the Genes?

Cancer occurs due to environmental factors which damage cell DNA. DNA damage may accumulate over a lifetime past the point of repair, and this damage leads to cancer formation. Certain genes are responsible for overseeing cell replication and cell repair, most notably BRCA 1 and BRCA 2. When there is an alteration in those genes, the body is at a disadvantage to repair cells, and cell growth may become erratically rapid. Altered genes can be inherited from both parents. According to the American Cancer Society, a woman with a BRCA1 or BRCA2 gene alteration has, on average, 45-87% increased risk of developing breast cancer by age 80.

“If you are concerned about your family history of cancer, knowing your own personal risk can provide a sense of relief from uncertainty when you have a family history of certain diseases and help with making informed decisions about your own health,” says St. Joseph Hospital Cancer Care provider, Mary Schmitt, APRN.

What is Genetic Counseling?

Genetic counseling refers to guidance from a specialized healthcare professional (doctor, genetic counselor, or nurse practitioner) provided to individuals and their families. Cancer and known gene alterations are traced through the family history and used to assess the benefit of testing. The genetic testing is done with a blood or saliva sample, and typically will be covered through insurance if recommended by your doctor.

The counselor may then discuss prevention options with you, especially if your personal risk is high. Medical management options for hereditary breast cancer risk include increased surveillance, medications to reduce breast cancer risk, preventative surgery, and recommendations for family members. For young women whose mothers or family members have had breast cancer, it is highly recommended that they start receiving breast cancer screenings five to ten years before they reach the age of diagnosis of youngest family member.

Who Benefits from Genetic Testing?

Genetic testing is not recommended for everyone; only 5-10% of breast cancer cases result from inherited genetic alteration. But inheriting an altered gene may increase your lifetime risk of developing cancer.

The following groups are encouraged to discuss genetic counseling options with their doctor:

  • Individuals with Eastern European or Ashkenazi Jewish Heritage – this ethnic group is one of the highest in terms of gene alterations
  • Families in which a man has developed breast cancer – about 20% of men with breast cancer have a gene alteration which also places them at risk for prostate and pancreatic cancer
  • Persons whose family member has a known hereditary cancer syndrome
  • Families with a relative who developed breast cancer before the age of 50
  • Individuals with a family history of prostate or pancreatic cancer

St. Joseph Hospital offers comprehensive breast care which includes genetic risk assessment and counseling, as well as radiation oncology, infusion therapy, and experts to navigate you through risk assessment.