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Telephone Disclosure Visual Aid Toolkit This is your visual aid toolkit that will be used during your disclosure appointment. Included in this packet are: Definitions and descriptions of things that will be discussed during your disclosure An Example of what genetic test results can look like This example can look a little different from what your real test result will look like Please remember, if you will be receiving your results by telephone, you will be asked for your password at the start of your telephone disclosure. Please remember to have your visual aids available IF you are receiving your results by telephone. 1 Make the test result page two– maybe save as jpeg to paste content 2 Possible BRCA1 and BRCA2 Test Results There are 4 possible test results: Positive: A mutation in either BRCA1 or BRCA2 is found in the person who BRCA1 and/or BRCA2 testing. This means that a person with a positive result has an increased risk of breast cancer, ovarian cancer, and some other types of cancer. No Mutation Found: True Negative: A BRCA 1 or BRCA2 mutation has already been found in another family member, and the person being tested has not inherited that mutation. The risk for some types of cancer for a person with a true negative test result is thought to be no higher than the general population. Uninformative Negative: No mutation has been found in BRCA1 or BRCA2. This is different from a True Negative result because no other family member has been tested and found to have a mutation. It is unclear with this type of result if the cancer[s] in a family are due to BRCA1 or BRCA2 mutation. This type of result is more informative for a person with certain types of cancer than it is for individuals with no personal cancer history Variant of Uncertain Significance: An alteration in the genetic code of BRCA1 or BRCA2 has been found but it is not clear what this result means for cancer risk. What a genetic counselor or doctor can tell a person with this type of result about their risk for certain cancers could change in the future as more is learned about the variant. 3 Understanding a Positive Test Result A mutation has been found in either BRCA1 or BRCA2. This mutation puts a person at an increased risk of developing breast cancer and/or ovarian cancer, as well as some other cancers. Recommendations to help you manage your cancer risk might include: Increased cancer screening Chemoprevention [medications that reduce cancer risk] Preventative surgery Lifestyle changes First degree blood relatives of someone who has tested positive for a BRCA1 and/or BRCA2 mutation have a 50% chance of having that same mutation. This includes a person’s mother, father, sisters, brothers, sons and daughters Other relatives of an individual who test positive for a mutation, like aunts, uncles, nieces and nephews, may also have that same mutation. 4 Understanding a True Negative Test Result Individuals with a True Negative test result have not inherited a BRCA1 and/or BRCA2 mutation that was previously found in a relative. Because there is no mutation, an individual with a True Negative test result has a risk of developing cancer similar to that of the general population. Most often, individuals who test True Negative are recommended to continue using the same cancer screening recommendations that are given to the general population. 5 Understanding an Uninformative Negative Test Result No mutation was found in the BRCA1 or BRCA2 genes. What this result could mean about you and your family: There are no mutations in the BRCA genes in you or your family. The cancer[s] in either you and/or your family may have been caused by other factors that are not understood right now OR Someone in your family who has not been tested does have a mutation in the BRCA genes, but you did not inherit it OR There is a small possibility that you and/or someone in your family has a mutation in either BRCA1 or BRCA2 that cannot be detected by the current technology OR There is a possibility that you and/or someone in your family have a different type of gene mutation This can be in a completely different or more rare gene OR A mutation in a gene that science has not yet discovered a way to detect Further testing of additional family members may help clarify results. People with this type of result are given recommendations based on their personal and family history of cancer. 6 Understanding Variant of Uncertain Significance Test Result A Variant of Uncertain Significance is an alteration that has been found that we are unable to interpret at this time. Currently, we don’t know if it is harmful or not. The risk for breast, ovarian and other cancers cannot be fully understood at this time. People with a Variant of Uncertain significance are given recommendations based on personal and family history of cancer. Blood and/or tumor samples from other relatives may be asked for to further study this Variant and cancer risk. This type of test result might be reclassified in the future. These results may not be available for a long time. 7 Risk for Cancer [women] [Percentages may vary slightly from resource to resource] LIFETIME RISK FOR BREAST CANCER: GENERAL POPULATION = 12% BRCA MUTATION CARRIER = 40 to 80% LIFETIME RISK FOR OVARIAN CANCER: GENERAL POPULATION = 1.5% BRCA MUTATION CARRIER = 10 to 45% 100 General Population 90 80 BRCA Mutation Carriers 70 40-80% Cancer Risk (%) 60 50 40 30 10-45% 20 10 0 Breast Ovarian 8 Risk for a Second Primary Breast Cancer [women] [Percentages may vary slightly from resource to resource] LIFETIME RISK FOR A SECOND PRIMARY BREAST CANCER: GENERAL POPULATION = 8% BRCA MUTATION CARRIER = 50 to 60% 100 90 80 70 60 50 40 50-60% General Population BRCA Mutation Carriers 30 20 10 0 9 Lifetime Risk of Cancer [men] [Percentages may vary slightly from resource to resource] LIFETIME RISK FOR MALE BREAST CANCER: GENERAL POPULATION = 0.1% BRCA MUTATION CARRIER = 1 to 10% LIFETIME RISK FOR PROSTATE CANCER: GENERAL POPULATION = 16% BRCA MUTATION CARRIER = 15 to 20% 100 General Population 90 80 BRCA Mutation Carriers 70 Cancer Risk (%) 60 50 40 30 20 15-20% 10 1-10% 0 Breast Cancer Prostate Cancer 10 DEFINITIONS Alteration - A change in the usual DNA sequence of a particular gene. These can be harmful, beneficial, or neutral in their effect on cell function. Cancer Screening - Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), and the Pap test and HPV test (cervix). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test. Chemoprevention - The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. Disclosure - Another term used to describe the appointment when you receive your test results. First Degree Blood Relatives - Mother, Father, Sister, Brother, Children Genes - The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Inherited - Transmitted through genes that have been passed from parents to their offspring (children). Mutation - Any change in the DNA of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial, or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; if mutations occur in other types of cells, they are not inherited. Certain mutations may lead to cancer or other diseases. Pedigree - A diagram that shows relationships among family members. In medicine, a pedigree may also show the pattern of certain genes or diseases within a family. 11