Get Counseling Before Genetic Testing

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When a woman asks about genetic testing and hears the response, "Oh, it's just a blood test," I want to scream. Genetic testing is far more than just a blood test, or at least it should be. Think about it. The results of a genetic test need to be taken seriously. What do the results mean? What action will you take if you test positive as a carrier of a breast cancer gene? There's also a trickle-down effect: what do the results mean for your siblings, your children? That's quite a lot to take in! Some breast centers, though, simply draw blood without first referring the patient to genetic counseling. I think that's wrong. A woman needs to be informed about what the genetic test results may mean for her and her family. Even issues such as whether she wants her insurance company to know she is getting tested need to be considered. And what about the woman who tests positive? It's really up to her. That's why getting counseling before genetic testing is so important. Will she decide to take proactive and preventive steps such as a bilateral oopherectomy (removal of both ovaries) and bilateral mastectomy (removal of both breasts)? Will she opt instead for more aggressive monitoring? Even among women whose risk may be quite high, say a 70 percent risk of developing breast cancer, not every one of them will decide to have preventive surgery. If a woman chooses not to do preventive surgery, can her insurance company classify her as having a pre-existing condition and refuse to cover her medical expenses if and when she gets breast cancer? The answer may be "yes." Is she psychologically prepared to get the genetics test done? Has she talked with her siblings about this? Again, there's a domino effect. If you find out you carry a gene that places you at higher risk for breast cancer, what does this mean for your children? They each have a 50 percent risk of getting that gene. Testing them, however, isn't recommended until they are of age. My own daughter was 16 years old when the test was developed. When I first brought up with her the possibility of getting genetic testing for myself, her response was, "Gee, Mom, I'd rather you wait. Let me be a kid for now." This was a profound response from a teen who feared I had the gene and that her breasts were doomed. So I waited until she was ready to hear the news. When she turned 24 and had begun thinking more about her own breast health and planning her own family, I was tested. That was the "right time" for us. What does a negative test result mean? Well, frankly, it's not a guarantee that you don't in fact have a breast cancer gene. Researchers suspect the existence of BRCA 3, 4, and who knows how many more such genes yet to be discovered. One important function of genetics counseling is to discuss your family's cancer history tree and understand whether your family history of breast cancer is more than a coincidence. If you are considering genetic testing or are being advised to pursue it, request genetic counseling first.