Breast and ovarian cancers aren’t the only cancers with mutations that can be inherited. Mutations in other genes can cause colon, pancreatic and prostate cancers as well.
German and British researchers recently identified changes in several genes that could lead to a test for susceptibility to pancreatic cancer. Researchers in Finland and in Washington, D.C., are studying mutations in a gene that could identify men at risk for prostate cancer. A test is already available for Lynch syndrome, inherited mutations that increase risk for colorectal, uterine and ovarian cancers. Lee P. Shulman, MD, a geneticist at the Feinberg School of Medicine at Northwestern University in Chicago, is enrolling women at high risk for breast and ovarian cancers who are BRCA-negative. He is investigating a gene called KRAS; acquired (non-inherited) mutations in this gene have already been implicated in other cancers, such as lung and pancreatic.
Shulman envisions a time when genetic testing will take a more prominent role in office visits to primary care physicians. He is concerned that technology is advancing far ahead of clinicians’ abilities to use that information to change how they care for patients. Just as when doctors listen to your heart and order tests if they don’t like what they hear, the same thing will happen on a regular basis with genetic screening.
Increased testing will bring results that physicians can’t explain, Shulman says. “The technology has raced ahead of the analytical capabilities and some of the ethical issues.”
“The worst thing for me as a geneticist is not a positive result or an abnormal result, because we are trained to take people through that,” he says. “The worst thing would be to say, ‘There’s a change in your genome, but we don’t know what it is’ and then not be able to provide any information. We have to be more cautious, not because patients can’t handle the truth but because we don’t understand the truth.”