Testing minor children for breast cancer risk needs to be a public policy for all children who have risk characteristics. We need to take advantage of all opportunities to help a child lead the healthiest life possible. It is our duty as members of society. It does take a village to raise a child after all. A village includes families and the medical community. Public policy can be developed and initiated to make sure children from age 16 to 25 have an opportunity to test for BRCA1/BRCA2.
All cancers begin due to genetic mutations. Mutations are changes in DNA cells. Some changes in a DNA’s genes, proteins and chromosomes start before a person is born. This is the case when children inherit cancer cells. Experts tell us 50 percent of inherited breast cancers start from mutated forms of genes called BRCA1 and BRCA2. A genetic test is available to learn whether the BRAC1/BRCA2 mutations can be found in a person’s genes.
In fact inherited mutations in BRCA1 or BRCA2 genes are the most important predictors of early breast cancer onset. Two thirds of all the inherited cancers fall under the category of BRCA 1/BRCA 2 mutations. Younger women are particularly at-risk for inherited breast cancer even though the mutations can be found in all ages of both males and females. Even if there is no history of breast cancer in the family onset breast cancer genes are found in up to one third of patients tested.
We all have good intentions to teach our children healthy life choices. As parents we will take the responsibility more seriously if we know our child definitely has a higher risk for cancer than the average. Children need to learn and live a healthy lifestyle. The earlier they learn the better. What are some other causes of cancer that can impact risk? A person’s age because as a person grows older more mutations develop over time. Cancer tumors result after enough mutations have formed. Another cause is the quality of environment. An environment with high pollution raises the risk of cancer. Many other unknown reasons have been indentified including plain bad luck. These factors work together to cause cancer. When a child is predisposed to another factor is added which raises their cancer risk.
So why is public policy needed? A policy needs to be in place to make sure everyone who needs the test is eligible for genetic testing. There are three important reasons we need to address this problem. Reason one is because some people who qualify for tests are overlooked. Reason two is because genetic tests are expensive and most people cannot afford them. Reason three is because when people take the tests more family members will follow their example.
Minorities need a legal right to receive testing so they will have the opportunity to take the test. The decision of who needs to be test can be narrowed down by taken into account family history. If multiple cases of breast or ovarian cancers have been diagnosed in the family, especially the same side of the family in close relatives, in two or more generations and when family members younger than 50 years have had breast cancer. Families with a Ashkenazi Jewish heritage are more susceptible to breast and ovarian cancer as inheritable diseases. If members of an Ashkenazi Jewish family have been diagnosed with breast and/or ovarian cancer than other family members need to be tested.
A public policy will make resources available for genetic testing. A full genetic test costs thousands of dollars in private clinics. A genetic test for a patient with Ashkenazi heritage can cost up to $1000 and more. The type of test to identify a family line of mutations also costs about $1000 and can cost more.
People who take the test discuss take the test and talk about the results with their family. Research shows that a person who has taken the test will be 75% more likely to talk to their spouses and more likely tell sisters, parents, brothers and daughters about the results.
Talking within families about genetic testing is critical because family members will take genetic tests. Relatives of the patient are more likely to take the test when one family member has already done the test. A study showed as many as 50 percent of sisters follow their sister’s lead take follow-up genetic testing. Male relatives, brothers and fathers, also followed their relative’s lead and took the test.
What are the advantages? Taking a genetic test relieves the worry and anxiety that are caused by uncertainty. Having the test results for a child allows parents and all the child’s care givers to be more realistic about what needs to be done. Practical measures to lower the risk of cancer can be taken. A lifestyle plan that reduces risk can be made and followed.
What are the disadvantages? The tests may not give conclusive results. Without special policies in place genetic testing is not affordable by most people.
What if your child’s test results show BRAC1/BRAC1 mutations? Once a test has been taken the genetic information will be available in a patient’s records. Doctors can use the test results to help their patients have the best treatments possible. We need to know if our children are at risk so we can make healthy life choices for them. We can also teach them healthy habits they can practice through their lives.
What can be done to reduce overall risk for high risk children? Children can be taught that if they avoid tobacco, use alcohol in moderation, eat healthy food and exercise help reduce cancer risk. Role models of good lifestyle habits are important along with lessons. Children at-risk need to eat as little fat as possible, avoid obesity, and learn to make a habit of exercise. They also need to lean to drink alcohol only moderately because over-drinking like over-eating raises a person’s risk for cancer.
Equal access to BRAC1 / BRAC2 is essential for children ages 16 to 20 when they are at risk for inherited cancer. Public policy will make genetic testing available to everyone who requires it. Their ethnicity or living in a poor family will not prevent them from having the access they need to have information about their risk of cancer.
Carroll, J. and Allanson, J. ‘Hereditary breast/ovarian cancer’, Presentation at Mount Sinai, Toronto, Ontario, CA, The Genetics Education Project, Ontario’s Health Council, 2009, Power Point available online and from http://www.mountsinai.on.ca/care/family-medicine-genetics-program/resources/BRCA_module_Final_2009.ppt.
Cheung, E.L., Olson, A.D., Yu, T.M. Han, P.Z. and Mary S. Beattie. (2010) ‘Communication of BRCA results and family testing in 1,103 high-risk women’, Cancer Epidemiology, Biomarkers & Prevention, 2010;19:2211-2219, Published online and available from doi: 10.1158/1055-9965.EPI-10-0325
Melhem-Bertrandt A., Bojadzieva, J., Kaylene J.R. et al., 2012 ‘Young onset HER2 positive breast cancer is associate with germline TP53 mutations’, 118(4): 908–913. Available from doi:10.1002/cncr.26377