Genetic Counseling for Breast Cancer

Jennifer R. Klemp, PhD, MPH

Certain factors increase the chance a woman will develop breast cancer. Cancer risk and genetic counseling assists women in understanding how personal and family history of cancer may increase the likelihood of a hereditary cancer syndrome. Genetic testing further refines this risk by identifying mutations associated with an increased cancer risk. Education and options empower women in managing their cancer risk and reduces any false sense of security that may come with negative genetic testing.

Referring patients for cancer risk and genetic counseling is much more likely to result in appropriate testing, a better understanding of personal risk for breast and related cancers and appropriate screening and risk reducing strategies while providing information for future generations.

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Genetic counseling takes comprehensive approach

When community physicians refer a patient to The University of Kansas Cancer Center for cancer risk and genetic counseling, we consider a number of factors. It’s important to note that the process does not always include genetic testing.
  • The number of genetic cancers in the family and age at diagnosis are critical factors (both maternal and paternal history are critical).
  • The type of breast cancer is another critical factor. Triple negative breast cancer (endocrine negative and HER-2-neu negative) appears to have a higher association with BRCA1 and BRCA2 mutations.
  • Based on these assessments and other factors, we determine appropriate candidates for genetic testing.
  • Often, affected family members can also be included. Then we test the individual at highest probability for carrying a gene mutation.
  • We consider insurance issues and do our part to help the patient pursue coverage.
  • We educate the patient and family on federal regulations protecting against discrimination based on genetic information.
  • Based on the individual’s level of risk, screening options and preventive strategies are recommended.
  • We provide follow-up recommendations and will collaborate with referring providers in navigating the patient and their family to appropriate resources.

Counseling gives patients control 

Genetic counseling and testing gives information to both the patient and family members. We often find that some family members would prefer not to have the information. Again, we can help with education and support. Knowing their risk status can help patients make decisions about initiating cancer screening and risk reduction. It also can relieve anxiety about cancer risk. Ultimately, the knowledge gained through the process tremendously increases the power patients feel over their own lives. 

New test underscores importance of process

New genetic testing modalities - looking at a panel of about 20 genes – is an example of how genetic tests are becoming faster and less expensive. They promise to improve the amount of information we can consider when assessing breast cancer risk. But the process is far from definitive. The art of interpreting the more complex genetic data reinforces the need for comprehensive counseling and follow-up services.

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