A conversation with Drs. Alan Ashworth and Pamela Munster on BRCA
Mutations in the BRCA1 and BRCA2 genes not only increase the risk of breast and ovarian cancers, but also increase the risk of pancreatic, prostate, and skin cancers. With information on a patient’s individual genetic risk, physicians at UCSF can now personalize treatment and prevention strategies.
Q. Which patients are at risk for hereditary cancer?
A patient’s family and personal history of cancer may indicate the presence of a harmful gene mutation. Risk factors include:
* Personal or family history of cancer, including a history of early-onset of multiple cancers, or multiple relatives with the same or related cancers
* An inherited genetic mutation linked to cancer in the family
For BRCA risk specifically, UCSF recommends that men and women undergo evaluation if they have family members with breast, ovarian, tubal, or peritoneal cancer, or a first-degree relative with pancreatic or prostate cancer diagnosed at a young age.
Q. What help is there for these patients?
“We provide the most current information on hereditary cancers related to BRCA and other common cancer mutations, and put that into clinical practice,” says Alan Ashworth, PhD, FRS, co-director of the Center for BRCA Research, president of the UCSF Helen Diller Family Comprehensive Cancer Center, and a key part of the team that co-discovered the BRCA2 gene. UCSF’s Hereditary Cancer Clinic offers genetic counseling, screening, prevention education, care coordination, and development of new treatment protocols—focused specifically on patients with hereditary cancer-linked gene mutations.
Q. How should I advise a patient who has uncovered a higher risk of cancer through a commercially available genetic test?
The Hereditary Cancer Clinic can arrange for evidence-based genetic testing and a complete family assessment based on the latest medical research. If a test reveals a genetic mutation that increases one’s cancer risk, UCSF has teams of disease-specific specialists experienced in providing comprehensive care surrounding inherited risk factors.
Q. How can I counsel family members of BRCA-positive patients?
The first step is testing for other family members. Family members of BRCA-positive patients who choose testing may learn of an inherited mutation well before any cancer diagnosis. “People who have only the risk factors but haven’t been diagnosed with a cancer don’t always know where to go. We can provide comprehensive clinical consultation and recommendations.” says Pamela Munster, MD, co-director of the Center for BRCA Research and director of the cancer center’s Early Phase Clinical Trials Unit.
Q. What is on the horizon?
“We’re thinking about preventive strategies for all BRCA-related cancers,” says Dr. Ashworth. “While prophylactic surgery such as bilateral prophylactic mastectomy or salpingo-oophorectomy currently offer the best chance for preventing BRCA-related cancer or halting its progression, our long-term goal is to uncover other options.”
To learn more about the Hereditary Cancer Clinic or make a referral, call 415-353-9797.