Cancer Genetics Matters

When to get genetic testing: BRCA Milestones

Milestones – life is filled with them. Some are based on age: driver’s license at 16 or legally drinking at 19. Others are based on life circumstance such as getting married or owning a home. Culture, religion and even having a BRCA gene mutation can create new milestones that we pass on our road through life.

BRCA Milestones dictate when and how medical care can change. They can also help people at 50% risk for a BRCA gene mutation decide when they want genetic testing – if they decide to have testing at all. If someone tests negative for the BRCA gene mutation in the family, their road changes and BRCA Milestones no longer apply to them. If someone with a BRCA gene mutation in the family declines genetic testing, we screen them as if they are BRCA carriers for good measure.

Milestones for Genetic Testing of BRCA1 or BRCA2

  • 18 years of age: In Ontario 18 years of age is the generally agreed upon age for young adults to consent to genetic testing for adult onset conditions like Hereditary Breast and Ovarian Cancer. Although exceptions to this “rule” may be made on a case-by-case basis, age 18 is typically the youngest age we offer genetic testing to people at 50% risk of having a BRCA mutation.
  • 25 years of age (women only): At Sunnybrook, 25 years of age is when female BRCA carriers may be followed in our High Risk Breast Clinic. Screening in this clinic involves clinical breast examination.
  • 30 years of age (women only): At age 30, female BRCA carriers may be enrolled in the Ontario Breast Screening Program for women at high risk of breast cancer. At Sunnybrook women are seen in the High Risk Breast Clinic and receive annual mammograms and breast MRI unless they are pregnant or breast feeding.
  • 35 years of age (women only): Between the ages of 35-40 we recommend female BRCA carriers have both ovaries and fallopian tubes removed to prevent ovarian and fallopian tube cancer.
  • 40 years of age (men only): At Sunnybrook 40 years of age is when male BRCA carriers may be enrolled in our Familial Prostate Cancer Clinic. Screening in this clinic involves an annual PSA test, physical examination and clinical breast examination.
  • Thinking of having children: If you are a BRCA carrier, there is a way to prevent the BRCA mutation from being passed on to the next generation. The process is called Preimplantation Genetic Diagnosis (PGD). PGD involves in-vitro fertilization where a sperm fertilizing an egg outside of the body. The resulting pre-embryo is tested for the gene mutation. The pre-embryo without the gene mutation is implanted into the womb. PGD is not covered by OHIP and to some people PGD is an ethically charged option.

About the author

Justin Lorentz

Justin is a genetic counsellor and Male Oncology Research and Education (MORE) Program Lead.

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