October is breast cancer awareness month. For most of us, this is a reminder to start doing our own self exams. If we are over the age of 40, it is time to make an appointment for a routine screening mammogram. However, breast exams and mammograms are not the only ways to stay on top of our breast cancer risk. Most cancers are sporadic, but some are due to mutations in genes that run in our 
families. For some of us, our family history can change our risk for breast cancer as well as and other types of cancer. A careful evaluation of family history often changes patient screening and management.
Passing down cancer through genetics…
While several types of cancers arise secondary to genetic predispositions, the hereditary breast and ovarian cancer syndrome is perhaps the most well known. Germline mutations in the BRCA 1 and BRCA 2 genes account for most cases of hereditary breast and ovarian cancer syndrome. The BRCA 1 and BRCA 2 gene mutations give an individual a 45-85% chance of breast cancer by age 70 and a 39-46% change of ovarian cancer (including fallopian tube cancer and primary peritoneal cancer) by age 70. Other cancers with genetic predispositions include those of the gastrointestinal tract, uterus, brain, kidney/urinary systems, prostate, pancreas and melanoma.
Dad matters…
There is a misconception that the paternal side of the family doesn’t matter with regards to their medical history. Because your father contributes half of your genetic makeup, his family history is just as important. Proper screening for increased risk of cancers, starts with a detailed family history. We update your family history annually at your wellness visit. It is very helpful to bring information with you regarding your family history to your visit. This includes first and second degree relatives affected by cancer as well as the ages of diagnosis. Your provider will use this information to determine whether or not you are a candidate for hereditary cancer genetic testing and if you might benefit from a referral for further genetic counseling.
How is the genetic testing performed…
Prior to testing, an appropriate professional provides genetic counseling and informed consent. At this time, your provider or genetic counselor explains the potential benefits, harms, limitations and possible outcomes of genetic testing. Sampling typically involves the collection of a blood or saliva sample. If the saliva test is performed, remember not to eat or drink 30 minutes prior to testing. Once your results are back, we will review them with you and tailor future screening and treatment to your individual needs. Your results may have an impact on your close relatives and their decisions to proceed with hereditary cancer genetic testing. Thus, cancer screening can truly be, a family affair.
