Risk assessment

Should you consider genetic counseling?

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By The Edith Sanford team

April 7, 2014

Kristen-de-BergIf there’s a history of breast cancer in your family, you may have a lot of questions concerning your own risk for developing the disease.

To help provide some answers, we spoke recently to Kristen De Berg, a certified genetic counselor here at Sanford Health. She did a great job of bringing clarity to some frequently asked questions about genetics and breast cancer risk.

Q: What is hereditary breast cancer?

KDB: About five to ten percent of breast cancer cases are hereditary, meaning the cancer is caused by one defective gene that gets passed down the family tree. In these cases, we’re looking at multiple generations of a family that are being affected by similar types of cancer.

A slightly larger percent of breast cancer cases are considered familial, meaning they’re the result of minor genetic factors, combined with aging and environmental and lifestyle factors.

By and large, however, most women who develop breast cancer have little or no family history of breast cancer–their cancer is what we refer to as sporadic. Sporadic cancers generally occur at later ages, due primarily to the aging process and environmental and lifestyle factors.

Q: Who should see a genetic counselor?

KDB: We welcome anyone who has concerns about their family health history.

The purpose of seeing a genetic counselor isn’t to have testing, it’s to assess whether testing needs to be considered. Our role is also to educate you about your risk and your options for managing your risk.

Essentially, genetic counselors facilitate the decision making process. It is the patient’s decision whether they choose to pursue genetic testing or not.

Q: How should I prepare for an appointment?

KDB: It’s so helpful when people think about their family’s health history before they come in. We always like to have at least a three-generation history — you, your parents and your grandparents — and what cancers they’ve been affected by. If you can go beyond that, even better!

We’ll sit down to see who in your family has had what type of cancer, and that will help us decide whether there might be a possible link.

I also always remind people that their family health history isn’t static. Things change, so make sure to keep your doctor and/or genetic counselor updated.

Q: How can you tell if I’m at high risk for breast cancer?

KDB: We can actually calculate a woman’s lifetime risk for breast cancer based on her personal history and her family history.

If you’re at a higher than average risk (more than 20 percent), we’ll make an action plan. For instance, maybe screening should be done more frequently than just once a year.

If we feel that there is a risk for hereditary cancer, we look for all the possible causes. And then we help determine who in your family is the best person to undergo the testing.

Q: You wouldn’t automatically test someone who is at high risk?

KDB: No. I know most people think that if there’s a hereditary risk in the family, well, who cares who’s tested? But in reality, it matters a lot.

If you want to find out if there’s a hereditary cancer risk in your family, the best person to test is someone who has had the cancer we’re concerned about. Here’s why…

Let’s say we have a 50-year-old woman who is diagnosed with breast cancer. If we test her for the BRCA mutation, and she tests positive, then we can pretty confidently say that her cancer was caused by the BRCA mutation. If she tests negative, then we can start looking for other causes.

On the other hand, let’s say that woman’s daughter comes in, and she tests negative. That result could be falsely reassuring because we still won’t know what caused her mother’s cancer in the first place. There might be other hereditary issues in play.


Kristen De Berg is a certified genetic counselor at Sanford Health who specializes in oncology and women’s health.

Learn more about risk factors for breast cancer.

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