Breast Cancer Genetics Health Chat

Health Chats

Breast Cancer Genetics

Wednesday Sep 23, 2009, 12:00PM - 01:00PM (EST)

Charis Eng, MD, PhD

Department Chair and Founding Director

Cleveland Clinic

Genomic Medicine Institute, Cleveland, OH

Can your genes predict your future? Join Dr. Charis Eng, Chairwoman and Director of the Genomic Medicine Institute at the Cleveland Clinic, for a live chat and get answers about how genetics impacts the likelihood of being predisposed to breast cancer from one of the world's foremost experts in cancer genetics. The Genomic Medicine Institute is poised to significantly change the way we practice medicine as we know it today. It builds on current knowledge by performing ground-breaking innovative genomics (all your genes together) and focused genetic research (one or a few genes), results of which can be utilized to tailor healthcare to each individual. If they are successful, in the future it will be possible to accurately predict who is at risk for certain diseases, such as breast cancer, so that clinical screening and lifestyle changes can be instituted, and be able to choose specific drugs with the highest likelihood of response and least likelihood for side effects. Dr. Eng is leading the charge to dramatically change the way medicine is practiced at the Cleveland Clinic. Dr. Eng grew up in Singapore and Bristol, UK, and entered the University of Chicago at the age of 16. After completing a PhD and an MD at its Pritzker School of Medicine, she specialized in internal medicine at Beth Israel Hospital, Boston, trained in medical oncology at Harvard's Dana-Farber Cancer Institute and was formally trained in clinical cancer genetics at the University of Cambridge and the Royal Marsden NHS Trust, UK. Dr. Eng and her outstanding team analyze the links between family medical history and disease predisposition. For example, each woman in the general population in this country is at 11% lifetime risk of developing breast cancer, however if a breast cancer gene is mutated (changed or has faults), the lifetime risk of developing breast cancer can be up to 8 times as high (80%). Currently, 8 breast cancer disposition genes have been identified. The focus of this Health Chat will be on understanding genetics and genomics and their impact on prevention and treatment of breast cancer.

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Charis Eng, MD, PhD:

The brief answer is yes, but there are no studies to show this. Prophylactic mastectomies will reduce >90% breast cancer risk in BRCA1/2 mutation positive individuals.

MedHelp:

Hello everyone...please continue to submit your questions.

ginsa:

I have an incomplete family history. My mother and 2 aunts all died before age 55. However my youngest sister just had both breasts removed with stage 1 and stage 0 cancer.

Charis Eng, MD, PhD:

It sounds as though your family health history should be assessed. so the best thing is for you/your family to be evaluated by cancer genetics professionals/genetic counselors

Michael:

I was dx'd with Stage 1 adenocarcinoma, Her2Neu positive (96%) back in 1998. Does this increase my daughter's risk of getting breast cancer?

Charis Eng, MD, PhD:

May I assume you are a male? If so, male breast cancer (esp early onset, ie, <65 years) should be seen by a cancer genetics profressional. If you are Jewish, even more so.

Sandy M:

Thank you for answering our questions today! I live in a rural area and I don't think we have genetic counelsors. Also I'm not sure I understand what a genetic professional does and how a genetic counselor would be beneficial. I do have a family history of breast cancer. My Mom had Triple Negative Breast Cancer and sadly she died 4 years ago. I am 29 years old - what would you suggest I do? Should I have a mammogram? Should I see a genetic counselor? How would I find a counselor in my area?

Charis Eng, MD, PhD:

You are very welcome. You may be surprised - if you look at the NSGC web site (www.nsgc.org), you may find some near your home. You should see a cancer genetics professional/genetic counselor for sure. For a peek at what genetics professionals do, see http://www.lerner.ccf.org/gmi/cpgh/

pedinurse:

Is there a genetic predisposition toward some types of cancer (i.e.: breast, ovarian, cervical)? Is the BRCA test reliable?.

Charis Eng, MD, PhD:

5-15% of all cancers have a genetic predisposition. A gene test is only as reliable as whom you test and which gene (there are 8 breast cancer genetics, not just BRCA) is selected to test.

kinina:

What is the survival for stage 1 triple negative poorly differentiated carcinoma after 6 chemo treatments TAC?

Charis Eng, MD, PhD:

You ask a very good question, but today’s health chat is dedicated to breast cancer genetics questions. MedHelp and the Cleveland Clinic are hosting another health chat - “Innovations in Surgical and Non-surgical Treatment for Breast Cancer” on Tuesday Oct 06, 2009 from 12:00PM - 01:00PM (EST). Joseph Crowe, Jr., MD, who is the Director of the Breast Center at Cleveland Clinic will be available to answer your important questions during the health chat. Here is a registration link:

http://www.medhelp.org/health_chats/register/29

Eddy126:

Four years ago I was diagnosed with breast cancer. A few months ago, my routine lab test showed my ALK is up to 122 and I did another test a month ago which showed it came down to 115. I did a bone scan and result was normal. Can you tell me why it is going up and down?

Charis Eng, MD, PhD:

Alkaline phosphatase (what I assume you mean) is a measure of several things, and not just liver function (there is eg placental alk phos)

goatgirl:

I've heard a lot about genetic testing lately - both pro & con. Some people say, if you find out that you are at risk, what will you do with that information? Others say that it is important to know what your risks are so that you can work to prevent cancer. In your opinion, how important is genetic testing and why?

Charis Eng, MD, PhD:

Great question. In the proper setting and with evaluation by genetics professionals, gene testing is very helpful because it does help inform preemptive screening.

iam1butterfly:

What would be the value of genetics counseling since I obviously can't alter my genetic make-up? I'm childless and past my child bearing years... so passing on the gene factor isn't an issue with me.

Charis Eng, MD, PhD:

If you happen to find yourself gene mutation positive, it confers risks of second cancer or other cancers, so genes inform your own healthcare management as well.

Charis Eng, MD, PhD:

cldubsokind:

What is your take on neoadjuvant chemo prior to surgery for removal of a 10 cm breast tumor? I would like to try and kill any micro-metastesis cancer cells that may already be floating around. I think that if I wait months before starting chemo I may give the cancer more time to spread while recovering from surgery. I am asking for neoadjuvant chemo, mastectomy, radiation, then chemo for treatment. I want the least chance or recurrence. I have grade 2 invasive ductal carcinoma with lobular cancerization. ER+/PR+/HER2 neg Mass about 10 cm Staging still unknown/nodes unknown. I am 32 years old and would love to live till the ripe old age of 70 at least. What is your take on this treatment approach? I hope that in the future clinical trials will show neoadjuvant chemo is very benificial. Any input on this matter?

Charis Eng, MD, PhD:

nevaeh279:

I was told to have a biopsy because I had an abnormality in my left breast but if I decide not to have this done then to come back in November for a check up and have a ultrasound done. What do you think about this?????

Charis Eng, MD, PhD:

PoetikkApoztle:

I was diagnosed with having BiRad 4 Suspicious abnormalities, I have 2 -One 9mm x 5mm smooth hypoechoic nodule at 2 O'clock 3cm away from the nipple. On the left side there is a 1.4 cm x 0.8 cm smooth hypoechoic solid nodule at 12 O'clock peri-aerolar region...I am so nervous can u explain this to me and what does hypoechoic mean?

Charis Eng, MD, PhD:

Hypoeachoic is a descriptive term that means on ultrasound, there are less echos.

Carol 1:

Hi! I am 35 yrs. old. My sister was diagnosed with breast cancer at the age of 39. Thankfully she is doing well. My Grandmother died from Ovarian Cancer. My Dad has Prostate Cancer and my cousin was recently diagnosed with breast cancer. Am I at risk? If so, what do you recommend I do?

Charis Eng, MD, PhD:

Yes, it would appear you are at risk. So you should see your genetic counselor nearest you. And do bring your sister along (gene testing should always started with someone with a cancer)

Mirecall:

There is a family history of Thyroid, Uterine and Breast cancer. I am brca1+, should I be tested for Cowdens disease?

Charis Eng, MD, PhD:

Now that is a great question! I hate to give someone two genetic diagnoses but if you are unsure, please do come by to see a knowledgeable genetic professional.

McFly_Mad:

What are the general signs of breast cancer?

Charis Eng, MD, PhD:

hani76:

A question about genetic counselling. I read that breast cancer can be caused by genes other than BRCA1/BRCA2. If I go for a gene testing, would it help identify any other gene too. Do insurances cover genetic counselling? I'm afraid to ask my insurance company for the fear that any positive outcome might increase my insurance?

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