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OctOber is

MESSENGER POST MEDIA

BREASTCANCERAWARENESS

MOnth

Tin in.Bs s 

AFTER A MASTECTOMYBY Dr. Stephen Vega, MD, MeDical Director, BreaSt reconStruction, unitY hoSpital

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At the end o this year, at least 230,000 Americanwomen will have received a diagnosis o breastcancer. While that number is overwhelming, theprognosis on survival has increased every year orthe past 25 years. Many women will choose to havea mastectomy, a total removal o the breast, to treator prevent breast cancer. Though oten eective,mastectomies can have emotional repercussionsor women. To combat these struggles, women maylook to plastic surgeons or breast reconstruction

surgery, restoring their bodies to a place o comor t and condence.

Ater receiving a cancer diagnosis, women are oten araid, and the idea o amastectomy may ampliy their ear. The decision to get a mastectomy is anincredibly dicult one or women, and they oten nd themselves lacking

sel-condence, sex drive and a sense o emininity ollowing the procedure.The potential or breast reconstruction oers many o these women a silverlining when everything seems to be alling apart.

Breast reconstruction is an option many patients consider as part o theirhealing process. One o the most popular microsurgical options is the DIEP(deep inerior epigastric perorator) Flap. Essentially, this procedure takes theskin, at and blood cells removed in a “tummy tuck” and uses them to orma natural-looking breast. The plastic surgeon then places this breast moundin the patient’s chest. Using a microscope or loupe magnication, the plasticsurgeon can reattach the blood vessels that will eed the tissue o the newbreast.

Because this is a microsurgery (a procedure perormed using a microscope),

DIEP Flap surgery takes longer than implant reconstructions; howeverrecovery is aster than traditional procedures and because the new breasts arenatural, they have a much longer liespan than articial breasts, which otenneed to be replaced every 10-15 years. Other reconstructive fap surgeriesuse at, muscle and skin rom dierent parts o the body, like the SGAP faprom the buttocks, TUG fap rom the inner thigh and latissimus fap romthe upper back, to create new, natural-looking breasts. Flap choice is otendetermined by where you might have extra tissue or reconstruction.

Implant surgeries are still practiced regularly. Women who opt or implantswill need to be aware o the many associated risks. Articial breasts canrupture, encapsulate or leak. Many advances have been made in the implantmaterials to prevent rupture and leak, but when this happens surgery isindicated to remove the leaking materials. Studies have proven that siliconeis inert and not responsible or long term health problems, but many patients

ear the consequences o having silicone leak rom an implant, or simplyhaving oreign material in their body. Probably the biggest downside toimplants is their longevity. Most patients will need an exchange o implants10 years later or even earlier in the event o a problem. Studies also suggestthat long term satisaction with implants is not as high as it is with your owntissue reconstruction.

Many women may choose to have their reconstruction as part o theirmastectomy, leaving no time without a breast or breasts. As medicaltechnology constantly updates, however, women who have had mastectomiesmay opt or reconstruction ater months or years. It takes time to get used tothe loss o a breast, and it also takes time to think o the reconstructed breastas one’s own, even i it’s reconstructed through fap surgery. It’s important tohave support through this process, so talk with a mental health proessional

or other women who may have had reconstruction.

Following reconstruction, it’s important to continue seeing your doctor andperorm sel-exams. Reconstruction rarely, i ever, hides a return o breastcancer, but it doesn’t prevent its recurrence.

Though breast reconstruction is not essential to restoring physical health,there are copious mental health benets. Beyond simple cosmetic surgery,breast reconstruction can allow women who have been sidelined by cancereel like they’re getting their lives back to normal. From an emotional andphysiological standpoint, reconstruction can be one o the most benecialrecovery methods or breast cancer.

Dr. Stephen Vega completed his undergraduate studies at Amherst College and went to medical school at the University o Pennsylvania. He did his residency in plastic surgery at the University o Rochester Medical Center, as well as a

ellowship in microsurgery and breast reconstruction. Ater training, Dr. Vega remained on the academic aculty at the Universityo Rochester where he was dedicated to advancing the eld o breast cancer reconstruction. Dr. Vega has had specialized interest in microsurgery and more specically in DIEP/SIEA/TUG/SGAP ap reconstruction.

Dr. Vega has a private practice, Vega Plastic Surgery and Medspa in Pittsord,and directs a ellowship in reconstructive microsurgery or plastic surgery  graduates sponsored by the American Society o Reconstructive Microsurgery.He is also the medical director o Breast Reconstruction at Unity Hospital.

Unity Health System89 Genessee Street, Rochester 585-723-7000 www.unityhealth.org

As a breast cancer surgeon, there are two commonquestions I am oten asked by patients and riends:“What causes breast can cer?” and “How do I preventit?” Today, about 1 o 8 women in the United Statesis expected to be diagnosed with breast cancer inher lietime. But we can signicantly impact theoutcomes.

Minimize Controllable Risk Factors

While the exact causes o breast cancer are unknown, actors shown toincrease risk include:

Alcohol Consumption - Women who regularly drink more than 3-6 drinksweekly, more than two glasses o alcohol a day, or are chronic binge drinkershave higher rates o breast cancer than those who drink in moderation ornot at all.

Excessive Weight - Obesity, particularly ater menopause, seems to increasethe risk o breast cancer—possibly due to increased estrogen produced inat cells. Maintaining healthy weight through diet and exercise may aid inpreventing a host o health problems, including breast cancer.

Hormone Therapy - Combination hormone replacement therapy is thoughtto contribute to breast cancer risk. Consider using these therapies or theshortest possible time in the lowest doses, or using alternative treatmentsoptions. Good news about breast eeding and oral contraceptives: Studieshave shown that breasteeding can lower the risk o breast cancer. Currentevidence also suggests that oral contraceptive use does not signicantlyincrease risk, and i used or ve consecutive years in your 20’s and 30’s mayactually decrease your risk o ovarian cancer.

Be Aware of Risk Factors You Can’t Change

 Just being aware o certain actors can make a dierence in preventionand risk reduction. Talk to your physician about any o the ollowing:

A Personal History o breast cancer or high risk lesions

Age & Gender - Breast cancer occurs in women o all ages, and even men,but is much more common in women over age 50.

Family History - A amily history o breast cancer, ovarian cancer, certaincancer syndromes and gene mutations place you at higher risk or breastcancer.

Reproductive History - Menstruating beore age 12, menopause ater age55, or having children late or not at all, are actors that increase risk.

Radiation Treatments - Unavoidable high doses o radiation to the chest,such as during treatment or Hodgkin’s disease increases breast cancer risk—especially i treatment occurred during breast development.

DES - Women who took diethylstilbestrol (DES) in the 1940s to 1960s toprevent miscarriage, or who were exposed in utero, may have an increasedrisk o breast cancer.

Early Detection

The most powerul way to improve your odds against breast cancer is earlydetection. Breast cancer survival is strongly related to stage at diagnosis.Current data suggests the 5-year survival rate rom Stage 0 breast cancer isover 90 percent, while ve-year survival at Stage 4 is 15 percent. While earlydetection isn’t the only ac tor, it is a major one.

Two important components o breast cancer detection are:

Imaging - Mammograms are still our best tool to detect breast cancer early.Continued on Page 2...

imv y dds AGAINST BREAST CANCERBY BY lori MeDeiroS, MD, cM, FrcSc, FacS | MeDical Director, rocheSter general BreaSt center

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W s w bs  dETECTION an dIAGNOSIS?

BY StaMatia DeStouniS MD, Facr

A mammogram is a well knownscreening exam or breastcancer detection and has beenproven eective over severaldecades. In more recent yearsdigital mammography has beenimplemented and has allowedacquisition o images o eachbreast that are viewed by theradiologist interpreting the

mammogram on a computer workstation.

Each woman’s breast is unique in that it is made up o varying amounts o glandular, atty or brous breasttissue. The more brous and glandular tissue present,the more dense the breast tissue is and the morechallenging the interpretation o the mammogram maybe or the radiologist reading the study. What does thismean to a woman presenting or her screening study?I she has dense breast tissue (which is determined onlyby a mammogram) she must understand that densetissue reduces the ability or some breast cancers to bedetected. A small cancer may hide in the dense breast

architecture and it is dicult to identiy on a routinemammogram.

As o January 2013 a mandate was passed by New YorkState requiring patients be inormed o their breastdensity along with the results o the mammogram.I the breast was composed o dense breast tissue, arecommendation must be included or the patient tospeak with her primary care physician (amily doctor,or gynecologist) regarding additional screening teststhat may be helpul or early breast cancer detection.Additional tests may include breast ultrasound and orbreast MRI. The mandate’s goal is to inorm women o their breast density and allow discussion with womenand their doctors regarding their breast cancer risk andreview actors that may add to their risk o breast cancer.Risk actors may include: amily history o breast cancer,other related cancers and prior breast surgical biopsy

revealing atypical (precancerous) cells are a ew o theactors.

A mammogram that reveals dense breast tissue may limitthe ability o the radiologist to interpret the exam andalso may make breast sel exam by the patient and clinicalbreast exam by the patient’s doctor more challenging. Bygiving this inormation regarding breast density to eachpatient the belie is that women will understand someo the limitations o mammography and seek out theirphysician i a lump is ound on their breast sel exam, ori they have any change rom previous sel exams, even inthe ace o a recent normal mammogram. The educationand inormation is meant to empower women and allowthem greater participation in their breast care throughopen discussion with their physicians regarding potentialrisk actors and recommendations or additional testing.

A new technology made available in the last two years

is 3D digital breast tomosynthesis. This is a combinationstudy including the standard mammogram and a 3Dmammogram o each breast. This technology usesequipment very similar to a mammography unit whichtakes several images o each breast in the standard

projections. This allows visualization o dense breasttissue with less diculty and may help the radiologist bemore accurate in seeing through the breast tissue morereadily.

Breast ultrasound may be added as an additionalscreening test i the mammogram reveals dense breasttissue. Ultrasound is a sae, relatively inexpensive andeasily accessible exam oered by most imaging acilities.Ultrasound may help identiy non-cancerous massessuch as cysts, broid nodules, and scar tissue. Findingsdiscovered initially may be deemed suspicious enough towarrant a needle biopsy to diagnose the nature o thelesion. Thus ultrasound may identiy lesions that turnout to be alse alarms and lead to unnecessary additionalprocedures.

Breast MRI may be another test ordered in somecircumstances as an additional screening test or speciccases where the patient has a considerable lietime riskor breast cancer. I a woman has enough risk actorsto qualiy or an MRI exam this may be added to herscreening regimen or her breast health. Studies have

shown that women in high risk categories (such asstrong amily history o breast cancer, personal history obreast cancer at a young age) will benet rom MRI ascancers that may have gone undetected can be ound.This exam does not utilize radiation but it is a lengthyexam and requires specialized equipment along with aninjection o contrast material. This is not an examinationor women o low or average risk or breast cancer.

This is an exciting time or breast cancer detectionas many new and also well tested technologies areavailable. Inorming women about their breast densitymay lead to additional testing such ultrasound, MRI,and possibly needle biopsy. These additional examsmay identiy some breast cancers sooner. The beneto earlier breast cancer detection may outweigh the riskand healthcare cost o additional testing. Data will needto be collected over time rom the patients examined totell us how large the benets may be. The hope is that asnew technologies are available and patient inormationand education increases, women will ask questions romtheir healthcare providers and make inormed decisionsregarding their breast health.

Dr. Destounis is a radiologist at the Elizabeth Wende BreastCare, LLC. in Rochester, where she has been practicing since1993 ater completing her breast imaging ellowship atthe Elizabeth Wende Breast Clinic. In 2005, she became aClinical Associate Proessor o Radiology at the Universityo Rochester School o Medicine and Dentistry. In 2010,Dr. Destounis became an American College o Radiology Fellow and Society o Breast Imaging Fellow.

 She participates with several radiology committees locallyand is a past board member o the Eastern Division o the American Cancer Society. She is actively involved withresearch on topics such as Computer Aided Detection,

Breast Ultrasound, Digital Mammography, Breast MRI,and Digital Breast Tomosynthesis. Dr. Destounis is aninvited speaker locally and nationally or radiology seminars on breast disease topics and her clinical research. She has published several peer review articles in radiology journals.

lf f bs  ThE SuRvIvORShIp JOuRNEY

BY Michelle ShaYne, MD

You’ve just nished your lastround o chemotherapy orradiation. Emotionally, you’vebeen tested like never beore.You survived! Where do you gorom here?

The survivorship phase o breastcancer can present challengesas you ease back into yourdaily lie, and nd your ‘new

normal.’ You are joining a group o almost three millionbreast cancer survivors in the U.S. and growing thanksto breakthroughs in research, earlier detection, moreaccurate diagnoses and targeted treatments. Andwhile many o these survivors lead long and ulllinglives, cancer and cancer treatment can be ollowed bydelayed or long-term physical and emotional challenges,including ongoing atigue and memory decits, higherrisk o cancer recurrence, heart disease, depression andsexual dysunction.

Nothing can prepare you or a cancer diagnosis, but youcan plan or how to best manage the challenges andopportunities ahead as you move in to the next phase o your journey. With coordination rom your primary carephysician and oncologists, the ollowing are tips or howset your path through breast cancer sur vivorship:

Pace yourself. You can’t rush healing rom cancertreatment. Your “new normal” might include the amounto activities you can take on in one week, or easing backinto a work schedule.

Get the facts. Having inormation at your ngertips canbe settling and make you eel more in control o what’snext. Ask your oncology team or the details aboutyour diagnosis and treatment—the exact stage andtype o cancer, any surgery or procedures, what type o chemotherapy and the dose, as well as radiation dosagesand locations o the body it was delivered.

Find strength in your community. Hearing theperspective o someone who has walked in your shoescan help you cope with some o the emotional and

physical side eects o post-cancer treatment. Seek outbreast cancer support groups in your community, aswell as online, to connect with others eected by thedisease.

Become a “foodie.” A healthy liestyle is built on anutritious diet. Find a nutritionist that understands theunique needs o a breast cancer survivor. Find un waysto incorporate these oods into your daily routine, takea cooking class, or start a healthy supper club withriends.

Move your body. While this may not be easible at thebeginning o your recover, light physical activity willassist in leading a healthy lie moving orward. Yoga,hiking or dancing are just a ew un and engaging waysto get moving.

Understand what could come next. While you’ve just

had to process all o the inormation on your diagnosisand treatment, it is important to also understandthe possible late eects o the specic treatment youreceived.

Don’t be a hero. Cancer treatment can cause you tohave lingering pain, atigue and “chemobrain” thatimpairs your memory or ability to ocus. Don’t hesitateto call your oncologist to discuss ways o how to manageany symptoms or address any questions you might have.

It is common to be anxious about your health andeveryone is unique in the way that they cope. Remember,every cancer survivor is dierent—some require moreinormation and support services than others dependingon diagnosis and treatment. Dening what wellness isor you and setting a path to being healthy again will only

help you better enjoy the next steps o your journey.The James P. Wilmot Cancer Center at the University o Rochester Medical Center is helping patients navigatethe complexities o breast cancer survivorship care withthe Judy DiMarzo Survivorship Program—the rst in theregion to ofer this comprehensive approach to survivorship.The ultimate goal o the program is to become a regional resource or all cancer survivors and work with primary care physicians and community programs across the region tobest serve this growing population. For more inormationabout the program, please call 585-275-6956.

 Michelle Shayne, M.D. is a breast oncologist and the clinical co-director o the Judy DiMarzo Survivorship Programat the James P. Wilmot Cancer Center at the University o Rochester Medical Center. Dr. Shayne’s clinical and researchinterests are in breast cancer and survivorship.

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The American Cancer Society and other specialtygroups concerned with early detection recommendmammograms starting at age 40. Women at high risk,including those with very dense breasts, may benetrom additional, complementary tests such as MRI andultrasound.

Physical Exam - Physical exams are critical to supportearly detection. At each exam, your doctor shouldphysically check or suspicious lumps, skin or nipple

changes, or unusual nipple discharge that occurs withoutmanipulation. Regular sel-exams are also important.Women who practice breast sel-awareness are more

likely to notice and report changes earlier than those whodo not—resulting in aster detection an d treatment.

Treatment

I you or a loved one is diagnosed with breast cancer,don’t panic. With today’s state-o-the-art treatments,there’s an excellent chance o surviving the disease. Oncediagnosed, be sure to quickly seek out treatment witha team o compassionate, knowledgeable caregiversthat you trust. Breast cancer is common and scary, butawareness o risk actors, proactive steps towards a

healthy liestyle and screening, combined with medicalskill and expertise help us improve the odds every day.

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Embrace Your Sisters(EYS) began in 2005when a group o riends

wanted to nancially andemotionally help another

riend with breast cancer. They continued undraisingand realized the incredible need o others in the area.Many people diagnosed with breast cancer are unable

to work during their illness or treatment, which adds ahuge nancial toll to an already dicult struggle.

This entirely volunteer organization lls a unique

emergency nancial assistance. A grant rom EYS canhelp with mounting co-pays and medical expenses. Itcan also help patients with rent/mortgages, utilities, andother necessary expenses in order to maintain quality o lie and a stable environment.

EYS also provides breast cancer education regarding theneed or sel and doctor examinations, mammogramsand the availability o ree mammograms. The recently

completed Kim’s Breast Cancer Support Handbook  isavailable at www.embraceyoursisters.org.

For more inormation please contact Sue Cooney, Embrace

Wm’s c TO MAkE EvERY MOMENT COuNT

BY anne JohnSton, corporate Writer/Marketing coorDinator, thoMpSon health

Each year, more than 10,000 women receive breast-imaging services rom Thompson Health, which islaunching a $2.5 million capital campaign or a newWomen’s Health and Wellness Center in Canandaigua.

Located just across Parrish Street rom ThompsonHospital, the new acility is expected to break ground in2014 and will provide:

• Same-day testing and results, availableat the same location

• Private access to all breast imaging services

• A Navigation Team to ensure immediate accessto emotional, fnancial and spiritual support as well as coordinate all necessary appointments

Thompson Foundation Director Anita Pietropaolo says

Thompson is meeting the current diagnostic needs o the community with top-notch doctors, nurses anddiagnostic imaging specialists as well as the mostadvanced technology available. However, scheduling

demands on acilities and equipment make it impossibleto provide an immediate transition rom one diagnostictreatment to the next. “The ability to receive same-dayresults takes away th at degree o uncertainty,” she says,adding, “Even when there is a diagnosis o cancer, havingthe results immediately allows a woman and her careteam to begin making treatment plans right away.”

In addition to conducting screening and diagnosticmammography, breast ultrasounds, biopsies, breasttomosynthesis, drainage and localization procedures,the Women’s Health & Wellness Center will oer bonedensity testing.

The capital campaign will not only und the constructiono the acility, but endow the position o a nurse acting asa breast health navigator.

To learn more, go to www.ThompsonHealth.com.Donations may be made online by calling the F.F. ThompsonFoundation at 585-396-6155.

 tms s wm TO LEARN ABOuT BREAST dENSITY

BY WenDeY MulhollanD | Director oF DiagnoStic iMaging For thoMpSon hoSpital

When it comes to breast health, you’ve no doubt heardabout the importance o yearly mammograms andmonthly sel-exams, but one thing you may not haveheard much about is breast density.

It’s something getting more attention in recent monthsdue to a new law in New York State requiring healthcareproessionals to inorm patients i dense breast tissue isound during an exam.

So what is breast densityand why does it matter?

Basically, breast density is based on the amount o brousor glandular tissue in the breast versus the amount o atty tissue. When a radiologist reads a mammogram, heor she compares the amount o atty tissue to the amounto brous or glandular tissue and then categorizes thebreast density on a scale, with 1 being almost entirelyatty tissue and 4 being extremely dense.

According to the law that took eect Jan. 1, patients whoare in category 3 or category 4 are to be inormed o theirbreast density when they receive the routine letter that

ollows a mammogram. This inormation is also sharedwith the patient’s physician in the routine ollow-upreport.

There are two reasons why it’s important to know your breast density:

• Dense tissue in breasts can make it harder to discernareas o concern within the breast, making it harder todetect small breast cancers.

• While common, dense breasts—determined by geneticmakeup—are among the risk actors or breast cancer,along with a number o other actors including amilyhistory, weight, diet, exercise and smoking.

More than 10,000 mammograms and breast ultrasoundsare perormed each year. She says the new state lawpertaining to breast density helps ensure that womenhave more inormation when it comes to empowering

themselves or better health. “It’s about awareness morethan anything else,” Mulholland says.

A patient whose breasts are ound to be dense is urged

to speak to her physician, who can then weigh all o thepatient’s risk actors and determine whether urtherscreening may be warranted. This can include breastMRI and/or ultrasound, both o which are available at

Thompson.Whether a woman has dense breasts or not, the mostimportant thing is to keep up with regular mammograms,which are recommended by the American Cancer Societyor women over 40.

“We certainly don’t want women to eel that they don’thave to go or mammograms as oten i they have lowbreast density,” she says, noting that the AmericanCollege o Radiology, the Society o Breast Imagingand the American Cancer Society are among severalorganizations promoting mammography as an eectiveand valuable tool in detecting breast cancer.

For more inormation about breast density and mammography guidelines visit the website o the AmericanCollege o Radiology at www.mammographysaveslives.org. For inormation about diagnostic imaging services

ofered by Thompson Health at Thompson Hospital inCanandaigua and at Thompson Urgent Care in Farmington,visit www.ThompsonHealth.com.

In 2014, Thompson Health plans to build a women’s center across the street rom the hospital in Canandaigua, withsame-day testing and results, private access to all breast imaging services, and a navigation team to ensure immediateaccess to emotional, fnancial and spiritual support, as well as coordination o appointments.

Q an AJeSSica SalaMone, certiFieD genetic counSelor at elizaBeth WenDe BreaSt care, llc

Over the past several years,advances in the eld o cancergenetics have given patients andtheir providers the opportunityto determine predispositionto certain cancers, includingbreast cancer, in order to initiateproper medical management.Although multiple risk actorsor breast cancer are known,

personal and amily history o cancer are key elementsimpacting cancer risk.

Jessica M. Salamone, ScM, CGC, certied geneticcounselor, provides comprehensive cancer riskassessment and genetic counseling services or patientsat Elizabeth Wende Breast Care, LLC. The goal o theCancer Risk Assessment and Genetic Counseling Programis the early detection and/or prevention o breast andother cancers. She also sees amily members, and men,who may also have an increased risk o breast cancerwith a amily history.

Up to 10 percent o breast cancers and 15 percent o ovarian cancers are considered hereditary. O these, themajority are due to mutations in one o two major breastcancer susceptibility genes, BRCA1 or BRCA2. Womenwith mutations in BRCA1 or BRCA2 have up to a 50

percent risk o breast cancer by the age o 50 and up toan 87 percent lietime risk o breast cancer. In additionto the risk o breast cancer, BRCA mutations coner up toa 44 percent lietime risk o ovarian cancer.

Ms. Salamone saw nearly 800 patients last year alone.She says each patient is unique, arriving with his or herown personal history, thoughts, belies, personality,and knowledge. Although the topic is the same, shenever says the same thing twice. Each patient receivedpersonalized care. Below she answers some o the mostcommon questions she hears.

Who should pursue BRCA1 or 2 genetic testing?

Breast cancer is incredibly common. Approximately 1 in8 women (12 percent) o women are diagnosed in theirlietime. Genetic testing is certainly not indicated inevery instance. Genetic testing or BRCA1 and 2 shouldbe considered in individuals who have a personal or

amily history o:• Breast cancer diagnosed before the age of 45

• Pre-menopausal breast cancer 

• ”Triple Negative” breast cancer 

• Ovarian cancer diagnosed at any age

• Male breast cancer 

• Two primary breast cancers in the same individual 

• Both breast and ovarian cancer in the same individual 

• Two or more breast cancers in the family,when both are under age 50

• Ashkenazi Jewish heritage

• A family member with a previously identied BRCA mutation

Why do women pursue genetic testing?

Women typically all into one o two categories: personalhistory and amily history

Personal history - Individuals who have alreadybeen diagnosed with breast or ovarian cancer and areseeking inormation as to why they’re acing a diagnosis.Aected individuals might consider pursuing genetictesting to help in surgical decision making (ie shouldthey pursue lumpectomy or bilateral mastectomy),to help determine recurrence risks either or theirinitial cancer or another type o cancer or to help theiramily members understand their risks and begin anappropriate screening plan. I positive, women in thiscategory might choose a more aggressive approach totheir treatment plan due to a high recurrence likelihood.A woman with a positive genetic test drawn ater a breastcancer diagnosis might also consider a hysterectomy dueto an increased likelihood o ovarian cancer.

Family history - Individuals who are concerned abouttheir amily history and wonder how it impacts theirpersonal risk. They are typically pursuing genetic testingto help determine i their current screening practicesare sucient, to help determine their lietime risk o cancer/(s) and to help other amily members understandboth their risk and to begin appropriate screening. This

is the category o women, like Angelina Jolie, whomay make a risk-reducing surgery decision prior to apersonal diagnosis. Both prophylactic mastectomy andhysterectomy reduce a woman’s likelihood o cancer by90-95 percent. Those with a positive genetic test aregiven the option o screening or surgery as a means toreduce their cancer risks.

How much does testing cost?

BRCA1 and 2 testing is expensive, nearly $4,000.

However, when appropriate personal and amily historyconditions are met, insurance will typically cover thecost o analysis. This is one reason that having a geneticcounselor guiding a patient through the testing processis important. In some instances, testing can be ar lessexpensive depending on ethnicity and i a mutation haspreviously been identied within the amily. In th e lattercase, testing is only $400 but requires the patient toobtain their relative’s positive test result.

What happens at a genetic counseling visit?

There are usually two appointments, an intake and aresults appointment. The genetic counseling and testingprocess includes meeting with a genetic counselorwho will obtain your amily history and determine theappropriateness o BRCA1 and 2 testing. The counselingsession also includes an overview o genetics, discussiono the testing process and logistics, review o associated

cancer risks, medical management options, impact othe results on amily members as well as psychosocialcounseling.

Emotions oten include anxiety, stress, guilt anduncertainty about wanting to know your personal risko cancer. I interested, a patient can submit a blood orsaliva sample or analysis. Results are typically availabletwo to our weeks later.

During the results session and depending on what theresults revealed, the genetic counselor will discuss thebest clinical management plan. I an individual testspositive, they could have a lietime breast cancer risko 84-87 percent (compared to a typical woman’s risko 12 percent,) and a lietime ovarian cancer risk o 27-44 percent (compared to a typical woman’s risk o 2percent). In that instance, a woman would be given theoption o surveillance (yearly mammograms and MRI’sand/or transvaginal ultrasounds and bloodwork) orsurgery (mastectomy and/or hysterectomy).

NOTE: BRCA1 and BRCA2 mutations also coner a riskor prostate cancer, male breast cancer, melanoma,pancreatic and kidney cancers.

Are there other breast cancer genes?

Yes. BRCA1 and BRCA2 are just two o many breastcancer genes. Genetic testing is available or otherbreast cancer genes as well as other types o early on-set cancers syndromes. It is important to consult witha genetic counselor or medical geneticist i you’ve hadprevious negative genetic testing or BRCA1 and 2 andwonder i your cancer could be related to a dierent genemutation.

Should I be concerned aboutinsurance discrimination?

In May o 2008, the Genetic Inormation Non discriminati onAct or GINA, was signed into law. This law preventsAmericans rom being treated unairly because o dierences in their DNA. It prevents discrimination romhealth insurers and employers. GINA prohibits the useo genetic inormation in setting eligibility, premiumsor contribution amounts by group and individual healthinsurers. It also prevents insurers rom requesting orrequiring an individual or amily member to undergo agenetic test.

 Ms. Jessica Salamone has been a Board Certied GeneticCounselor since 2005. Beore joining EWBC, Ms. Salamoneworked at the University o Rochester Medical Center or 10 years, where she provided genetic counseling to patientsin a variety o clinical settings including reproductive, pediatric and cancer genetics. Ms. Salamone is alsoadjunct aculty at Rochester Institute o Technology, where she teaches medical genetics and introductory geneticcounseling courses. For more inormation please contact: Jessica Salamone, ScM, CGC. 585-758-7057.

Elizabeth Wende Breast Care, LLC  170 Sawgrass Drive/ Rochester, NY 14620  585-442-2190 www.ewbc.com