Quest Diagnostics adds BRCA gene testing: Should more women get test?

Quest Diagnostics

The nation's biggest medical lab testing firm, Quest Diagnostics, plans to offer a test for BRCA gene mutations, which are linked to increase risk for breast and ovarian cancers.

The test will be made available at the company's 2,100 testing centers throughout the country, which serve about 50 percent of U.S. doctors offices, according to the company.

The announcement comes months after the U.S. Supreme Court ruled human genes cannot be patented, which threw out the previously held BRCA test patent from Myriad Genetics Inc.

"The more people we can prevent from getting the diseases that we treat, the better," oncologist Dr. Richard Bender, a clinical professor of medicine at UCLA and consult for Quest Diagnostics, told

Bender hopes that expanding the availability of the test will enable more women at high risk of breast cancer to get it, since previously it was taken mostly by more affluent people with better access to care.

The genes known as BRCA1 and BRCA2 are "tumor-suppressing genes," according to the National Cancer Institute.

Less than 10 percent of breast cancer cases are caused by mutations in BRCA1 and BRCA2, and less than 15 percent of ovarian cancers are linked to the mutated genes. But if a person tests positive for the genetic variation, there's up to an 85 percent lifetime risk for breast cancer and up to a 40 percent risk for ovarian cancer, Dr. Myra F. Barginear, a breast medical oncologist at the Cancer Institute of North Shore--LIJ Health Systems, previously explained to

Not everyone should get a test looking for BRCA mutations, Bender emphasized.

Family history is a major predictor of this added risk. A woman may be at higher risk if a parent, sibling or other close family member died of breast or ovarian cancer before the age of 50, for example.

And the same may go for men as well. While more rare, men can get breast cancer -- more than 2,200 will be diagnosed this year, according to the National Cancer Institute. Almost all cases in men are related to BRCA mutations, Bender said.

Bender recommends making a detailed list of your family history as it relates to these cancers, then go to your doctor. A doctor would then utilize a genetic counselor -- Quest is teaming up with a third-party genetic counselor service -- to make sure the test is appropriate. A genetic counselor's backing could be required for insurance coverage.

A positive BRCA test result cannot tell whether a person will actually develop cancer or when, the National Cancer Institute points out.

Women who test positive may decide to undergo annual mammogram screenings at younger ages, beginning at age 25 to 35. The U.S. Preventive Services Task Force recommends routine mammograms in healthy women beginning at 50 years old. However, the Institute notes women who have a positive test result should ask their doctor about the risks of tests like mammograms and X-rays, since BRCA-associated cancers may be more likely to grow with radiation.

Women with a genetic mutation may also want to undergo routine breast exams at a doctor's office beginning at 25 years of age. And they can consider preventive drug treatment. Tamoxifen and raloxifene are the only two preventive drugs approved by the FDA for high-risk women, but some birth control pills have been shown to reduce risk as well.

In some cases, women with a BRCA mutation may decide to undergo preventive surgeries like a double mastectomy to remove the breasts or oophorectomy to remove the ovaries. While extreme, such procedures can reduce the chances of getting cancer for some high-risk women. However, studies have have shown little benefit for women in other cases.

BRCA testing has been an issue on the minds of many following Angelina Jolie's May 2013 New York Times op-ed where she disclosed that she underwent a preventive double mastectomy after discovering she had the BRCA 1 mutation.

Her mother died at the age of 56 after a 10-year-battle with breast cancer, which led Jolie to seek out the testing, she said.

"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could," she wrote. "I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex."

Jolie also announced her intention to have her ovaries removed to reduce her cancer risk.

Bender says Jolie performed a public service by getting women to think about their hereditary risk for cancer.

"I think all of us that have been in health care always want to try to do the best for our patients," the oncologist said. "The only way we can do that in my specialty is to have effective treatments, or be able to prevent disease or mitigate disease by knowing about it in advance."

The new BRCAvantage test will be offered beginning Oct. 15.

The National Cancer Institute has more information on BRCA mutations.