Pamela Munster (left), MD, is the co-leader of the new UCSF Center for BRCA Research. Photo by Barbara Ries
As more people get their hands on their own genetic data each day, many face an increasingly common question: What do you do if you carry a genetic risk factor for cancer?
While knowing genetic mutations can help clinicians decide on treatment options for patients, the data raises more questions than answers for family members or otherwise healthy individuals who carry risk factors. The newCenter for BRCA Research at UC San Francisco aims to address those questions.
Spanning basic and translational research, clinical care and education, the center provides a one-stop resource for patients and individuals who carry BRCA1 and BRCA2 mutations.
What’s often unrecognized is that individuals who carry BRCA mutations also have a risk for other cancers such as ovarian or pancreatic tumors, melanoma, or prostate cancer in men.
To the center’s co-leaders Alan Ashworth, PhD, FRS, and Pamela Munster, MD, their mission is clear: Rethink how we treat and manage hereditary cancers.
Patients, family members and individuals who carry risk factors such as BRCA variants have several unmet needs, according to Munster. For example, BRCA patients are often treated by specialists for the kind of tumor they were diagnosed with, while healthy family members are often seen not by oncologists but internists, who may not be equipped to handle their concerns.
“What’s often unrecognized is that individuals who carry BRCA mutations also have a risk for other cancers such as ovarian or pancreatic tumors, melanoma, or prostate cancer in men,” says Munster. “And people who only have the risk factors but haven’t been diagnosed with a cancer don’t always know where to go.”
A Patient’s Perspective
Both Ashworth and Munster are intimately acquainted with the mutations they’re targeting. Ashworth, president of the UCSF Helen Diller Family Comprehensive Cancer Center, helped discover both the BRCA2 gene and drugs known as PARP inhibitors that target cancer-linked biochemical pathways and are now approved for the treatment of BRCA1 and BRCA2 related cancers.
For Munster, the patient experience is one she has lived through herself. She was diagnosed with a BRCA2 mutation in 2012, and recalls the myriad decisions she had to navigate. “I had to figure out who would do my oophorectomy, pancreatic cancer risk screening, what I should do for my children. ... There was not a place where it was easy to coordinate my care,” she says.
At least one instance already exemplifies what a person who enters the new center might experience. Gail Fisher had a family history of cancer, and after undergoing three mammograms in 18 months to track a suspicious growth she took a genetic test that confirmed she carries the BRCA1 mutation.
She had read Munster’s personal story and briefly worked with her, so when she received her test results, she reached out for advice. Fisher recalls their meeting, where Munster spoke with her about expectations, prophylactic options, consults and more. Eventually, Fisher chose to undergo preventive mastectomies and a procedure to have her ovaries removed. A year to the day after receiving her genetic test results, she left the hospital after the surgeries.
“It was very powerful to have a doctor who so very much understood my experience,” says Fisher. “I think she played out with me her vision for the BRCA center at UCSF – that kind of very personal care – she really gave me a framework within which everything was contained.”
Streamlining Cancer Care
At the new center, patients, BRCA mutation carriers and their families will be able to receive information and genetic counseling about their risks, coordinate care across multiple specialists, and make informed decisions. Whether from ordering their own genetic history or because of tests the doctor ordered, more people face such decision-making each day. “Our goal is to just help people live as well as they can with this,” says Julie Mak, genetic counselor at the center.