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Genetic Testing for Breast Cancer: Creating the Big Picture

What you know about life with breast cancer is often just a snapshot.

Do you have the full picture?

Walking into your childhood home, you glance over and see your mother asleep in her easy chair. She doesn’t get up as much as you would like, but after her breast cancer diagnosis she doesn’t have the energy she once had. As you sit on the couch facing her you start to wonder a few things…

One. The treatment my mom chose for her breast cancer doesn’t seem to be working. What further information do we need to justify changing the treatment protocol? How do we move forward in the best way for her?

Two. Watching my mom slowly slip away is heartbreaking but also a bit unnerving on a personal level. Could this happen to me, too? What about my daughter?

Now take a look at the picture from a different angle.

Your daughter just walks in through the front door, you never leave it locked anymore. It’s too hard to get up. With your eyes half closed you watch her walk across the room and sit on the sofa facing you. The worry lines are etched in her face. She’s been a worrier since birth. You can’t help but think a few things…

One. I thought I made the best decision possible when choosing the treatment protocol for my breast cancer. But lately I’ve been hearing the doctors talk about knowledge of specific genes that give a better indicator of what treatments work best in fighting specific types of breast cancer. Is genetic testing right for me at this stage – especially since I’ve already been diagnosed?

Two. I’ve always been very overprotective of my family, so it makes sense that my daughter is worrying about me now. She comes by it naturally. I’ve been meaning to talk to her about the genetic testing my doctors mentioned. Will she get what I have? What about my granddaughter? Should my daughter go through the same genetic testing my doctors want me to go through?

Having the big picture is helpful when dealing with a breast cancer diagnosis – from both a personal and generational level.

Genetic testing for breast cancer can greatly increase the knowledge you have about your cancer and also the likelihood that future generations will inherit the genes. Knowledge is power in the treatment of breast cancer.

The most famous genes that greatly increase risk of breast and ovarian cancer are BRCA 1 and BRCA2. PALB2 is lesser known, but equally devastating. These genes are hereditary and contribute to between 5-10% of breast cancers worldwide. Having a mutation in one of these genes increases lifetime risk of developing breast or ovarian cancer to 72%. Knowing if you carry one of these genes can inform your own treatment options, as well as genetic testing and possible treatment for members of your family.

Are you wondering if you might have inherited one of the genes for breast cancer?

If you have a history of breast cancer in your family, or if you are of Ashkenazi Jewish descent you are most likely to have inherited the genes for breast cancer. It’s simple to know for sure. You can test yourself at home with The Color Test ordered online here: www.color.com. The Color Test is extensive and also affordable. It’s a simple swab inside your mouth you can do from home. And you only have to do it once to have all the information you need at your fingertips.

Have you already been diagnosed with breast cancer but you want to understand the big picture?

If you are already undergoing treatment and evaluation for breast cancer, you may receive a multi-gene test panel through your medical institution such as Myriad Genetics. Panels like this one identify known oncogenes for breast cancer like BRCA1 and 2, but can also provide information to inform chemotherapy and targeted options.  Foundation One or Guardant 360 are additional genomic tests for treatment planning and therapy evaluation, often used for advanced cancers.

Something to consider: Some patients who were diagnosed with simple breast cancer but weren’t tested genetically to start with found out later they had a significant genetic mutation. The treatment protocol they were given might have been different if genetic testing were done after diagnosis.

Another example: A patient with the P53 gene mutation for Li-Fraumeni syndrome would know that there is more breast cancer penetrance for female offspring with the genetic mutation but outcomes with radiation are far poorer. Because she didn’t undergo genetic testing right after diagnosis her team felt that radiation was the best course of action. Her protocols would have been completely different with a full genetic picture.

Arming yourself with the knowledge that you do/ do not have the genes for breast cancer can be a heavy weight to carry. A whole world of issues come up with this information.

After genetic testing and all that goes with it, what happens next?

• If you are taking the test to know whether or not you have inherited the genes for breast cancer: Take the test and then consult with your doctor about positive results and your treatment timeline and protocols.
• If you are undergoing genetic testing because you have been diagnosed with breast cancer, but you want to know more: Take the test and then get a referral for a genetic counselor to consult with you about your specific genetic coding.
• Once you have undergone genetic testing and are deciding on treatment protocols: Considering genomic testing to determine the need for chemotherapy might be the next step for you. Using the Oncotype DX Test or MammaPrint at initial surgery will give your team more information about how to proceed.
• If you have already undergone first line therapy (chemo and immunotherapy, check point inhibitors with specific molecular targets): The Guardant360 test is something to consider as it looks at gene targets for other therapies that might be beneficial to you.
• In conjunction with all other testing, there is functional testing that your naturopathic doctor can provide that will benefit your overall wellness during cancer treatment and beyond.

How does genetic/ genomic testing inform treatment from a naturopathic perspective?

There are so many things that are out of your control during cancer treatment. But, undergoing functional testing can help you get on top of the things you can control. We are learning more and more about how those very actions can change the genetic makeup of the cancer cells in your body.

There is a whole lot of testing that naturopathic doctors can do to determine the functionality of genes. Functional gene testing to check for Single-nucleotide polymorphisms (SNPs) – a variation in a single spot of DNA sequencing in genes – gives a better indicator of how specific nutrition, exercise, sleep, and stress management can detoxify pathways and eliminate excess estrogen.

Utilizing functional testing and adding a naturopathic perspective to your cancer treatment can physically change the way SNPs operate in your genes. You have the ability to shape the effectiveness of your own cancer treatment and can make a difference in preventing the recurrence of breast cancer in your body.

One of the naturopathic principles is doctor as teacher. We want to enable you with the most complete picture of your health so you are empowered to be and stay well. Genetic, genomic and functional testing are tools you can utilize to be proactive about breast cancer and whether or not you are likely to inherit or pass on the genes. The information you glean will be instrumental in your survival of breast cancer and will help to ensure that future generations in your family will as well.

As a naturopathic oncologist I am trained to safely manage complementary and alternative therapies for cancer patients undergoing conventional cancer treatments. I provide complementary medicine consultations regarding whole foods nutrition, botanical medicine, nutritional supplements, and lifestyle modifications to attain optimum health during cancer treatment and after.

Please contact Dr. Laura James ND, FABNO if you have questions about integrative solutions for your health care needs. If you live in the Bellingham, Washington area and would like to learn more about a naturopathic approach to your wellness, please call 360-738-3230 or CLICK HERE to schedule a consultation.