Welcome to the Public Health Perspective Series, the National Office of Public Health Genomics's highlights page. Breast cancer is one of the most common cancers occurring among women. Ovarian cancer, although not as common, is associated with a higher mortality rate than breast cancer. Genetic testing is available to look for mutations in two breast cancer susceptibility genes, BRCA1 and BRCA2. However, most cases of breast cancer/ovarian cancer are not associated with inherited susceptibility mutations.

This Public Health Perspective examines the topic of Genetic Testing for Breast and Ovarian Cancer Susceptibility:  A Public Health Perspective.

Because BRCA1 and BRCA2 mutations are not common, most women will not benefit from testing. However, for the small group of women who  are candidates, the choice for or against genetic testing for breast/ovarian cancer susceptibility may not be an easy one. The complexity of interpreting  genetic information, the uncertainty of the health outcome, and issues of privacy and discrimination surrounding genetics complicate the decision.

The following pages provide facts and resources to public health professionals to help women and their families understand hereditary breast/ovarian cancer and the implications of genetic testing for BRCA1 and BRCA2.

"Out of 10,000 women, 1000 will have a mother or sister who has had breast cancer, but only 15 have a BRCA1 or BRCA2 mutation that confers a high risk. It is estimated that in a primary care practice of 1000 patients, 1 case of inherited breast cancer will be diagnosed every 1 to 2 years, but 1 case of inherited breast cancer due to BRCA1 or BRCA2 mutation will be diagnosed every 20 years."
Linda E. Pinsky, et al
West J Med 2001;175:168-173

• Genetic Testing for Breast & Ovarian Cancer Susceptibility
  What is the role of public health in genetic testing for breast cancer susceptibility and how does genetic testing fit into the overall public health strategy for preventing breast and ovarian cancer?

• Fact Sheet on Genetic Testing for Breast & Ovarian Cancer Susceptibility

• What is Genetic Testing for Cancer Risk?  (last accessed 5/2007)

• Genetic Testing for BRCA 1 and BRCA 2: It's your choice.  (last accessed 5/2007)

• What is Breast Cancer?   (last accessed 5/2007)

• What is Ovarian Cancer?   (last accessed 5/2007)

• Lifetime Probability of Breast Cancer in American Women   (last accessed 5/2007)
  A National Cancer Institute (NCI) report estimates that about 1 in 8 women in the United States will develop breast cancer during her lifetime

• What Is Breast Cancer in Men?  (last accessed 5/2007)
  In 2004, some 1,450 new cases of invasive breast cancer will be diagnosed among men, and about 470 men will die from breast cancer in the United States.   More Resources   (last accessed 5/2007)

• About BRCA1 and BRCA2 (last accessed 5/2007)

• Breast and Ovarian Cancer: A Genomic Medicine Review   (last accessed 5/2007)
  Wooster, R and Weber, BL. 
  NEJM 348(23):2339-2347

• Overview of Genetics and Breast/Ovarian Cancer
  Breast Cancer Genetics : An Overview
  An expert review of the genetics of breast cancer.

• Mutation Tables for BRCA1 and 2 (last accessed 5/2007)

• Why should Primary Care Physicians know about Breast Cancer Genetics?  (last accessed 5/2007)

• Family History as a Risk Factor for Ovarian Cancer (last accessed 5/2007)

• Family History as a Risk Factor for Breast Cancer  (last accessed 5/2007)

• Do you have Breast Cancer in your Family? (last accessed 5/2007)

• National Breast Cancer Center, Australia   (last accessed 5/2007)
  Information for patients (and providers) about interpreting risk based on family history.
  
• Do You Have Cancer in Your Family?  (last accessed 5/2007)

• Ethical, Legal and Social Implications of Genetic Testing: 25 recommendations from the European Commission (2004) (last accessed 5/2007)
  
• Limitations of Direct-to-Consumer Advertising for Clinical Genetic Testing (last accessed 5/2007)

• B.C. to Resume Genetic Testing for Cancer (last accessed 5/2007)
  (February 15, 2003) CTV.ca reports, "Genetic testing for hereditary and ovarian cancer is set to resume in B.C. using new procedures that the provincial health minister believes won't violate U.S. patents."

• Better Understanding of Risk Assessment, Testing Leads Some Women to Decline Genetic Testing for Breast Cancer  
  (Nov 6, 2001) In a news release from NSGC, " New research suggests that while fears of insurance discrimination and high test costs are factors in some women's decisions to decline breast cancer genetic testing, the majority of those who decline the test may be doing so because pre-test counseling helped them better understand their genetic risk.

• Psychological Well-Being of Women Who Chose to Undergo Breast Cancer Genetic Testing Comparable to Those who Declined Testing
  (Nov 6, 2001) In a news release from NSGC, " Women with a family history of breast and ovarian cancer who chose to undergo genetic testing appear to experience no significant psychological distress about their decision to be tested, even when an increased cancer risk was discovered. Results of a NIH study on the topic are being presented this week at the 20th Annual Education Conference of the National Society of Genetic Counselors.

• North American Association of Central Cancer Registries (last accessed 5/2007)
  NAACCR is a collaborative umbrella organization for cancer registries, governmental agencies, professional associations, and private groups in North America interested in enhancing the quality and use of cancer registry data. The website contains information on cancer registries, including data on incidence of different cancers in the population.

• Mamma Care (last accessed 5/2007)
  A validated system for teaching physical examination of the breast.

• Ethical, Legal and Social Implications of Genetic Testing (last accessed 5/2007)
  An example of testing for hereditary breast and ovarian cancer susceptibility

• Cancer Genetics Services Directory  (last accessed 5/2007)
  This directory lists professionals who provide services related to cancer genetics (cancer risk assessment, genetic counseling, genetic susceptibility testing, and others). These professionals have applied to be listed in this directory.

• Cancer Support  (last accessed 5/2007)
  Support page from NCI for patients living with cancer. Includes facts sheets for other family members living with cancer, finances, insurance, support groups and other links.

• National Organizations That Offer Services to People With Cancer and Their Families  (last accessed 5/2007)
  A list compiled by NIH that describes organizations that provide cancer-related services to individuals with cancer and their families.

• Susan J. Komen Breast Cancer Foundation. (last accessed 5/2007)
  The ABCs of Breast Cancer

Provides link to non-governmental sites and does not necessarily represent the views of the Centers  for Disease Control and Prevention.