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How screening for a breast cancer gene is helping men

The Columbus Dispatch 9/28/2022 Peter Gill, The Columbus Dispatch

When a doctor recommended to Steven Kalister that he get screened for genes associated with breast cancer a few years ago, the Columbus Northwest Side resident was surprised.

Kalister, 50, did not have breast cancer — a disease uncommon (though not unheard of) among men — or any form of malignancy, for that matter. But his father had died from metastatic prostate cancer, so Steve was seeking precautions besides common tests like digital rectal exams and prostate-specific antigen screenings.

The oncologist, Dr. Steven Clinton at Ohio State University’s comprehensive cancer care center, explained to Kalister that mutations in two genes, known as BRCA1 and BRCA2, could have caused his father’s cancer, and might have been passed down to him. “BRCA” stands for Breast Cancer Gene, because that is what researchers first found it to be associated it with. However, science has since connected the BRCA genes with a range of malignant tumors that affect men and women, from melanoma to pancreatic, ovarian, and prostate cancers.

Kalister decided to take a simple blood test and learned that, indeed, he had a mutation in the BRCA2 gene. Since then, he has undertaken a variety of precautions that could help him ward off any significant tumor, and he shared the news with family members — who also got tested.

Kalister said he would encourage anyone who is thinking about genetic testing to go see a counselor.

“My wife thought maybe I’d get paranoid or have a lot of anxiety from these results. But that’s not the case at all. Knowledge is power,” he said.

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BRCA genes associated with more than just breast cancer

Researchers and clinicians say that the public’s understanding of BRCA genes needs updating. Because of the genes’ association with breast cancer and therefore cisgender women, until recently BRCA testing was not covered by insurance or encouraged for men diagnosed with prostate cancer but with no family history of the disease. 

However, recent research has shown that men with mutations to BRCA2 have a three-times higher risk of prostate cancer than the general population, and people with mutations in BRCA1 and BRCA2 are six and 14 times more susceptible to pancreatic cancer, respectively. Today, genetic counselors recommend that certain male cancer patients and men with family histories of cancer get tested for mutations in BRCA and a suite of other cancer-associated genes.

The BRCA genes code for proteins that help prevent cancer by fixing damaged DNA. 

Like everything in our bodies, DNA is susceptible to damage — from radiation, chemicals, or other factors, like random chance during the process of creating new cells. Cells containing damaged DNA can become cancerous if fixes are not made by DNA-repairing proteins. Mutations in the BRCA genes can create proteins that are less effective at fixing DNA damage, thus upping cancer risk.

Everyone has two copies of each BRCA gene — one from each parent — but only some people have harmful mutations in the gene. If a parent has a harmful mutation in either gene, each of their children has a 50% chance of inheriting it, according to Lindsey Byrne, a licensed genetic counselor at Ohio State University's Wexner Medical Center.

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Should you get genetic testing?

Byrne leads a genetics clinic at the OSU Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. As a licensed genetic counselor, she helps patients decide whether to undergo genetic screening, how to interpret results, and next steps.

Byrne encourages genetic testing for anyone with a strong family history of cancer, and for patients who have cancer at an early age or particularly aggressive cancers. 

That includes prostate cancer.

“I think there hasn’t been enough messaging to say: prostate cancer is something you should have genetic testing (for). There is a lot of media and coverage about breast cancer and genetics,” but the message was not as strong for prostate cancer until recently, she said.

Certain people may want to consider genetic screening based on their ethnicity. While only one in 400 individuals in the general population has a harmful BRCA mutation, that statistic rises to about one in 50 among Ashkenazi Jews, who trace their ancestry to central and eastern Europe.

Taking precautions to try to lessen cancer risks

Kalister works at The James as a service line administrator, but he said there was a lot he didn’t understand about cancer and genes until he sought out genetic counseling.

Knowing he is positive for a BRCA2 mutation has helped him take precautionary measures. He is more careful about sun exposure than he used to be (because BRCA2 is linked with melanoma), and tries to eat more healthful foods.

Byrne also helped him connect with an ongoing National Cancer Institute study, which takes MRIs of his prostate on a regular basis to detect any abnormalities.

So far, so good, he said. 

Kalister plans to encourage his twin 9-year-old sons, Ian and Colin, to get genetic screening as well — when the time comes.

“I’ll tell them about how it’s not scary — its about how you use that knowledge to your advantage,” he said.

Insurance covers most patients for genetic cancer screenings, but it depends on the policy and one’s medical and family cancer history, said Byrne. 

“Testing is very low out of pocket, and for Medicare and Medicaid patients, it’s usually zero out-of-pocket,” she said.  Medicaid and Medicare have covered genetic screening for metastatic prostate cancer patients since 2018.

Even if one were to self-pay, the cost of screening is just a few hundred dollars, compared to several thousand dollars a decade or more ago.

Although BRCA is a common genetic cause of cancer, it is not the only one. Byrne says she typically tests for a suite of 12 other genes, in addition to the two BRCAs.

Some genes that cause cancer — including prostate cancer — may have yet to be discovered.

For example, Black men, who are 60% to 80% more likely than white men to be diagnosed with prostate cancer, do not have higher-than-normal incidences of BRCA. 

“There must be something else going on,” said Byrne.

“It could be a combination of a whole bunch of small risk factors, or it could be a gene we haven’t discovered, and it’s because we haven’t studied genetics as much in individuals who are Black as we have in whites. The problem with some research is it’s not validated for all populations, and that’s a huge equity issue.”

How private is your genetic information?

Byrne says some patients come to her with privacy concerns over genetic testing, but she is usually able to allay their fears.

Unlike some companies that test DNA to identify relatives, none of OSU’s genetic testing partners share information with the police, she told The Dispatch.

Individuals are also protected by the 2008 Genetic Information Nondiscrimination Act (GINA), which prevents employers and health insurers from asking about genetic information when making decisions. However, exceptions are made for life insurance and long-term care insurers, who can ask for such information. It is often best to buy such coverage before undergoing genetic testing, said Byrne.

Kalister said that for at-risk individuals like himself, genetic counseling should be a no-brainer.

“The counselors are really really good,” he said. “This is what they do — they talk to people about this kind of testing, these results, they’re there to answer questions.”

OSU also provides Family HealthLink, a free online tool that estimates cancer risk by reviewing family patterns.

Peter Gill covers immigration and new American communities for The Dispatch in partnership with Report for America. You can support work like his with a tax-deductible donation to Report for America here:bit.ly/3fNsGaZ.

pgill@dispatch.com

@pitaarji

This article originally appeared on The Columbus Dispatch: How screening for a breast cancer gene is helping men

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