For women with family or ethnic backgrounds that point to a greater chance of developing breast or ovarian cancer, genetic testing can provide lifesaving options.
Women with a mutation on BRCA1 or BRCA2 genes are known to be far more susceptible to breast and ovarian cancers than the general population. Identifying these gene alterations can help women better understand the risks they face and the approaches they can take to lessen their chance of developing cancer.
Through interdisciplinary efforts and programs such as the Cancer Genetics and Breast Health (CGBH) fellowship, the University of Michigan Von Voigtlander Women’s Hospital is educating medical professionals about genetic testing and sharing how this screening can be most beneficial for patients.
“OB-GYN physicians typically aren’t provided sufficient training to ensure that they have all the tools to identify women with higher risks and prevent these serious cancers,” says Mark Pearlman M.D., the S. Jan Behrman Professor of Reproductive Medicine in the Department of Obstetrics and Gynecology.
“The CGBH fellowship focuses on educating the next generation of OB-GYN physicians so that they have the skills and knowledge necessary to prevent cancers and unnecessary deaths in young, healthy women,” Pearlman adds.
The CGBH fellowship is supported by generous contributions from Elisa and Jim Ross, and the Genetic Disease Foundation, of which Elisa is president. The fellowship is a unique, one-year advanced training program that allows a physician to build expertise and consult on genetic mutations associated with breast and gynecological cancers.
Kathryn Huber-Keener, M.D., Ph.D., is the current CGBH Fellow and works under Pearlman’s direction. Huber-Keener earned her medical and doctoral degrees from Penn State University and completed her residency at the University of Iowa.
“This fellowship is one of the only programs in the country that focuses on a cross-disciplinary approach to include gynecological, breast health, genetics, and surgery,” Elisa Ross says. “It’s so impactful because the fellows take what they learn to different parts of the country and spread awareness of this life-saving testing.”
Knowing the Risks
Having an inherited genetic characteristic does not mean a person will get cancer, but it does indicate a higher risk.
While mutations in the BRCA1 and BRCA2 genes are responsible for just 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers, women with these mutations face a significant risk of developing these diseases.
Studies have shown that 12 percent of all women will get breast cancer, and slightly more than 1 percent will develop ovarian cancer. For women with an alteration in either the BRCA1 or BRCA2 genes, the chances of getting cancer are staggering: roughly 70 percent will get breast cancer, and about 44 percent with a BRCA1 alteration and 17 percent with a BRCA2 mutation will develop ovarian cancer.
Physicians stress that not all women need to undergo genetic testing, but those with cancer diagnoses in their family history should consult their doctor to see if genetic screening is appropriate. Some key warning signs include:
- Several family members with cancer (especially breast and ovarian) throughout several generations, either maternal or paternal
- Family member diagnosed with cancer before age 50
- Family members diagnosed with multiple cancers (for example, breast and ovarian)
- Male breast cancers, or clusters of other cancers such as colon, prostate, stomach, or pancreatic
- Ethnic heritage or background with a high frequency of cancer
Taking Action to Save Lives
In addition to training provided by the CGBH Fellowship, Michigan Medicine is home to the Breast and Ovarian Risk Evaluation Program at the Rogel Cancer Center. The program provides accurate risk assessments for breast, ovarian, and other cancers, as well as education on genetic testing and research.
Genetic counselors help women understand individual risks and determine if genetic testing is the right option. Counselors, oncologists, surgeons, and other members of an interdisciplinary team help every woman understand her results and determine which ensuing steps are most appropriate. Personalized plans could include surveillance, surgery, medications, or lifestyle changes.
“BRCA1 was identified more than a quarter century ago, and breast and ovarian cancer can largely be prevented in these high-risk women through identification and preventive measures,” Pearlman says.
It is the expertise of individual specialists, the level of care they provide, and their ability to collaborate across disciplines that inspires Elisa Ross to support Michigan Medicine. Elisa and Jim hosted an event at their home with Pearlman; Dee Fenner, M.D., the chair of the Department of Obstetrics and Gynecology; and Jacqueline Jeruss, M.D., associate professor of surgery and director of the U-M Breast Care Center. The event sought to build support for U-M women’s health programs and grow understanding of cancer risks and genetic testing options for women who have a higher chance of developing cancers.
“I feel like this is an area that doesn’t get much attention, so we wanted to recognize Drs. Fenner, Pearlman, Jeruss, and the entire program at U-M,” Elisa Ross says. “They are doing extraordinary work to advance women’s health, and the care they provide is vital for women of a certain risk factor.”