Genetic Counseling and Ovarian Cancer: 4 Questions With an Expert
Jubilee Brown, M.D., answers some common questions about genetic counseling in patients with ovarian cancer.
BY Katie Kosko
PUBLISHED March 13, 2017
Cancer can strike randomly, or it can be a result of certain risk factors such as genetics. Genetic counseling can be an effective way for a person to better understand their risk for hereditary cancer. A counselor or health care professional will discuss your personal and family medical history, as well as predict whether you are likely to have one of the gene mutations — BRCA1 or BRCA2 — associated with an increased risk of developing ovarian cancer.
During the Society for Gynecologic Oncology (SGO) 48th Annual Meeting in National Harbor, Maryland, Jubilee Brown, M.D., professor and associate director of Gynecologic Oncology at the Levine Cancer Institute, Carolinas HealthCare System, Brown and colleagues are presenting a poster at the SGO meeting on how telemedicine and patient navigation may be successfully used to help deliver regional genetic counseling services to women diagnosed with ovarian or breast cancer. They found that with this model, the number of patients with newly diagnosed ovarian cancer referred for genetic counseling increased from 40 percent in 2013, to 58 percent in 2014 and 96 percent in 2015. Referral to genetic counseling in breast cancer also improved. The researchers concluded that overall, “successful implementation of patient navigation and telemedicine [consults] improved the delivery of genetic counseling to patients with ovarian and breast cancer despite geographic barriers.”
In an interview with CURE at the meeting, she offered advice on where to access this counseling and why it is so important for women with ovarian cancer to advocate for genetic testing.
What advice would you give patients regarding genetic counseling and how they can receive it?
The more we learn about genetic counseling and who should be seen, counseled and tested — the more this has opened up prevention opportunities for patients. I think it is really important for patients to be informed about their own risk and their family history. They should talk to their primary care providers about the testing that is appropriate for them and certainly anybody with a history of breast, ovarian, colon, endometrial and certain other cancers. Let those red flags come up, and talk with your provider about counseling and testing because it really could save your life.
Is there a certain cancer type or group of patients that responds better to genetic counseling?
It turns out that every single person with ovarian cancer really should be tested — and that’s a change. We used to rely on family history, but family history doesn’t uncover over half of ovarian cancers that are hereditary. Not only is that important for the patient with ovarian cancer because it can impact therapy, but it’s really important for all of the relatives of a patient with ovarian cancer who can be tested, and we can see if they are at risk for developing ovarian cancer.
How do fertility considerations impact decision making?
We are finding patients with BRCA and other related mutations at younger and younger ages. For example, I just saw a patient in the office who was 25 years old, and that is not unusual now because people know what their risks are and what their mutations are. So, we can start chemo-prevention with things like oral contraceptives very early on so that they can decrease their risk. They are aware of when they can intervene, so when they are finished with childbearing they can go ahead and have that preventive surgery.
Is there anything else that you would like patients ovarian cancer to know?
Every patient should be her own advocate. She should be aware of her family history and of other risk factors that she might have. Also, she should talk with her primary care provider about genetic counseling and genetic testing.