Breast Cancer Genetics Health Chat

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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:

Another great question: genetic counseling and genetic consultations are covered by most insurance companies. There are 6 other breast cancer genetics beyond BRCA1/2. So it is vital that you are assessed (you and your family history) to determine IF you are at genetic risk, and if so, which gene is most likely.

booboo123456:

I have a pea size lump at the top of my armpit. It gets a little larger around that time of the month. It is soft and easy to move around. Sometimes it goes away almost completely only to return later. There is no pain, no cancer in our family, not over weight. I am 46 and a light smoker. Does this sound like cancer? I have no insurance and can't afford medical care.

Charis Eng, MD, PhD:

You should seek medical attention

firecrotch69:

Hi Dr. Eng, my name is cyystal and my question is they did a genetics test on me and the 1st one showed i had the bcra1 or bcra2, but i just got another letter from the gentics lab and it said i have an unstudied gene, which they called it a mutation g gene, except now I'm high risk for blood clots, etc. Now it also said my 19 year old girl needs to be tested yearly and once our 11 year old girl shall need to be tested at 19 yearly, as well as my 29 year old sister my real mum died of the small cell cancer at just 47yrs old, but no link to the aggressive cancer in me. No one in my family had ovarian cancer. Can you please explain if my other 2 nieces 11 and 14, if they are to be tested as well. I'm getting a double mastectomy, except I'll need to be nutritionally healthy. We tried to do surgery in June but I wafter the feeding tube gets put in.

Charis Eng, MD, PhD:

This sounds pretty unusual to have mutations in both genes. I would suggest you show your results to a cancer genetic counselor before you act on it. If the gene test was not ordered by a genetics professional, then the wrong gene(s) may have been tested or a wrong interpretation.

brady0819:

Good Evening Dr; I am a 37 yr old female who had her first mammo and us on Tuesday. The found a 1.6cm solid mass on my right breast. It is somewhat irregular, with smooth borders, no calcifications and posterior acoustic shadowing. I saw a surgeon who said the mass was not palpable. We proceeded with an ultrasound guided needle biopsy. The results came back as "benign breast tissue". We are proceeding with a stereotactic biopsy this week. No one seems overly worried, but I am scared about the shadowing seen. Also - is it possible to have a final biopsy of simply "benign breast tissue"? We were hoping for something more in the biopsy report (ie; fibrocystic disease, etc.). Thank you very much for your help in this.

Charis Eng, MD, PhD:

If you are unsure, then you should obtain your pathology report and the actual slides and bring those for a second opinion at a major medical ctr

Rnbette:

My father's sister has breast cancer. My mom and her mom died at very young ages due to non-related issues but were not diagnosed with any form of cancer. Am I at risk because of my aunt?

Charis Eng, MD, PhD:

It does depend and you are astute to understand that breast CA can be passed down via a male. If you are concerned at all, then you should seek an expert assessment with genetic counselors

BK2005:

I have a family history of cancers. Also, I am Jewish and have heard that this increases my risk for cancer. What, if anything, can I do to lower my risk of cancer? Is there any new research showing what I can do to lower my risk? Are we any closer to preventing breast cancer?

Charis Eng, MD, PhD:

Since you are Jewish and have I assume breast and/or ovarian cancers in the family, you should seek expert assessment by cancer genetics professionals. And indeed, we do know how to prevent or catch cancers early in BRCA mutation positive folks.

snowman885:

Dear doctor, How could I know if I have such a problem like breast cancer? What are the signs? How can I check on my own? Thanks.

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

cutievet2009:

Good day Doctor. I had a lumpectomy last Aug. 23, 2009. 2cm and biopsy result was Fibrocystic changes with sclerosing adenosis.Last week i felt pain on my both breasts so i had an unltrasound. The result showed; NORMAL ECHOPATTERN OF BOTH BREASTS; 3 SIMPLE CYSTS ON THE LEFT BREAST, THE LARGEST IS 14.8 X 7,5mm; 4.6 X 3.6mm; 4.6 X 4.2mm; ON RIGHT BREAST 2 SIMPLE CYSTS; 7.6 X 5.1mm AND 9.2 X 4.5mm. NO CALCIFICATIONS SEEN. IMPRESSION; SIMPLE CYSTS, BOTH BREASTS. My questions are; do i have the cysts removed surgically? it is natural to feel frequent tolerable pains on both breasts? and I feel pains on both armpits and sometimes feeling of numbness, are these expected? is there a medicine that will dissolve breast cysts? simple cysts means ? I am worried pls help. TYVM DOCTOR. GOD BLESS.

Charis Eng, MD, PhD:

Hello - I think you should see a breast specialist. If you were in Cleveland, I would suggest Dr. Holly Pederson.

Jack615:

My wife has breast cancer - estrogen receptor positive. She is currently undergoing chemotherapy. We have two young daughters and I'm worried sick that they may be at risk. Is there anyway to tell if they are at risk?

Charis Eng, MD, PhD:

The best thing is for you/your family to be evaluated by cancer genetics professionals/genetic counselors so that a very complete family health history can be done and assessed

Carol 1:

What should I expect during a visit with a genetic professional and will a lot of "needles" and "blood" be involved?

Charis Eng, MD, PhD:

Fantastic question - the answer is no. See http://www.lerner.ccf.org/gmi/cpgh/ for a peek at what we do

pedinurse:

After my chemotherapy is complete, and assuming no sign of the metaplastic carcinoma is found, I intend to have breast reconstruction. What at the chances that the cancer will recur in the reconstructed breasts (I will have the other breast removed prophylactically & reconstructed at the same time)? Thank you.

Charis Eng, MD, PhD:

goatgirl:

My mother was the first female in our family to be diagnosed with breast cancer. Her type of cancer was HER2Neu positive, and negative for the BRCA1 gene mutation. Aside from a yearly mammogram, what kind of genetic tests are available to me to help determine my risk of getting breast cancer? Is the HER2Neu positive form of breast cancer hereditary?

Charis Eng, MD, PhD:

If your mum was Dx postmenopausally, you may not be at an increased risk at all. I assume she is also BRCA2 mut negative as well.

hani76:

My mother and both her paternal aunts have BC. However, my mom cannot get tested for the BRCA since she lives in a different country where the testing is not available. Will the testing be reliable if I get it done even though I do not have BC?

Charis Eng, MD, PhD:

Unless you are Jewish, it is best to start testing with an affected person (ie with the youngest cancer)

pdr7686:

My sister had cervical cancer and had to have a hysterectomy. Should I be checked for this?

Charis Eng, MD, PhD:

Once a woman is sexually active, she should have routine pap smears to check for cervical cancer

Michael:

How common is hereditary breast cancer?

Charis Eng, MD, PhD:

Approximately 5-15% of all breast cancers are due to genetic causes

T_O_N_I:

I am encountering discharge in my nipples. Is it also a symptom of having breast cancer? Thank You!

Charis Eng, MD, PhD:

There are many causes of nipple discharge including breast cancer. You should seek medical attention.

sk123:

There's no history of breast cancer in my family. My paternal grandmother died of stomach cancer and my maternal grandfather died of lung cancer (a smoker). Would you recommend that my sister, my mom, and I get tested just to be safe?

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