Hereditary Cancer Risk Assessment. Ms. Róisín Clarke Cancer Genetics Service St. James s Hospital 05/03/2013

Transcription

1 Hereditary Cancer Risk Assessment Ms. Róisín Clarke Cancer Genetics Service St. James s Hospital 05/03/2013

2 What is hereditary cancer?

3 Who is at high risk for hereditary cancer? Hereditary cancers account for only a small proportion of all cancer

4 How common are hereditary breast and ovarian cancers?

5 Hereditary Breast and Ovarian Cancer Breast Cancer Ovarian Cancer 15-20% ~5-10% ~12% ~70% Hereditary Sporadic Familial

6 Features of Sporadic Cancer Breast 69 Few relatives affected No specific pattern Diagnosed at an older age

7 Features of Familial Cancer Breast 50 Breast 55 A few relatives with same cancer No specific pattern Slightly younger diagnoses

8 Features of Hereditary Cancer Breast 40 Breast Breast 71 Many relatives affected in multiple generations Diagnosed at earlier ages Breast Breast 36 Ovarian 45

9 How are mutations in BRCA1/2 detected?

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11 BRCA1 and BRCA2 Genes BRCA1 185delAG 5382insC BRCA2 6174delT

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13 What are the chances of inheriting an altered BRCA1/2 gene?

14 50% Chance of Inheriting a Mutation Father Mother 1 in 2 chance for each pregnancy

15 50% Chance of Not Inheriting a Mutation Father Mother 1 in 2 chance for each pregnancy

16 Manchester scoring system

17 What are the types of BRCA test results?

18 Positive Result A mutation was identified in BRCA1 or BRCA2: THE CAR IS GRAY. THE CAR IS GRTY.

19 Negative Result No mutation in BRCA1/2 was identified: THE CAR IS GRAY. THE CAR IS GRAY. Cancer risks may or may not be increased

20 Uncertain Result A variant in BRCA1/2 was identified: THE CAR IS GRAY. THE CAR IS GREY. Cancer risk is not yet known

21 If a woman has a BRCA mutation, what are the options?

22 Risk reduction Options for Women with a BRCA Mutation Positive BRCA1 or BRCA2 test result Increased cancer screening Non-surgical prevention Risk-reducing surgery

23 Screening Options for Women with a BRCA Mutation Breast

24 Screening Options for Women with a BRCA Mutation Ovary Semiannual transvaginal ultrasound with color Doppler imaging Semiannual CA-125 blood levels

25 Options for Preventive Surgery Breast Risk Reducing Bilateral Mastectomy Reduces risk of breast cancer but does not completely eradicate it.

26 Options for Preventive Surgery Ovary Risk Reducing Oopherectomy Reduces risk of ovarian cancer Remaining primary peritoneal cancer risk Decreases breast cancer risk in some

27 If a man has a BRCA mutation, what are the options?

28 Screening Options for Men with a BRCA Mutation Positive BRCA1 or BRCA2 test result Prostate Breast Possibly pancreatic, melanoma

29 What are the possible risks and benefits of testing?

30 Whether or not you have a personal history of breast or ovarian cancer Testing may: Clarify your risk for ovarian or breast cancer Provide options for medical management Provide beneficial information for family members

31 Limitations of BRCA1/2 testing Does not detect all mutations; may not out rule hereditary risk Effectiveness of some early detection measures is not proven Continued risk of sporadic cancer May have implications for family members

32 If a person does not want genetic testing, what are their options? Continued appropriate screening Risk reduction measures

33 Referred to genetic service in 2008

34 What about insurance discrimination? Disability Act of 2005

35 Family updated in 2011

36 Diagnostic genetic testing

37 Risk clarification

38 vaginal ca dx68 throat ca dx47 dx NHL dx 19 breast dx 49 ovarian dx 56 ovary dx

39 CASE HISTORY-1 Mary is aged 57yrs and is terminally-ill with ovarian cancer which was diagnosed two years earlier. She also had BC at age 45 yrs. Her older sister died from ovarian cancer, which occurred at age 57 yrs. Mary has two daughters aged 34 and 30. Screening for a mutation in BRCA1 and 2 is negative.

40 vaginal ca dx68 throat ca dx47 dx NHL dx 19 breast dx 49 ovarian dx 56 ovary dx

41 dx throat dx 62 dx 52 carrier dx 54 NHL dx dx 38 R ight dx 39 Left dx 36 Right dx 43 Left dx 45 ovary

42 CASE HISTORY-2 Noelle was diagnosed with bilateral BC ages 38 and 39. Her sister was diagnosed with bilateral BC at ages 36 and 43 and OC at 45. Their mother died from BC at 54. Noelle undergoes genetic screening and a mutation in BRCA1 is found.

43 dx throat dx 62 dx 52 carrier dx 54 NHL dx dx 38 R ight dx 39 Left dx 36 Right dx 43 Left dx 45 ovary

44 CASE HISTORY- 2 COMMENTS. Testing of their mother revealed that she did not carry the mutation. Their father was identified as a carrier confirming the familial mutation was transmitted via the paternal line. Sporadic cancers occur in high risk families and testing of key individuals is important.

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46 Lynch syndrome MLH1 mutation