Health & Fitness

ON THE COVER

Cancer Gene Alert

Genetic screening joins other publicized weapons
in fight against breast, ovarian cancers.

Judith Doner Berne
Special to the Jewish News

T

o test or not to test for a hereditary
cancer gene is not the only ques-
tion for women with a family his-
tory of breast cancer.
Because if the gene screen is positive,
there is the further question of what to do
about it.
Dr. Dana Zakalik, a medical oncologist
at Royal Oak-based Beaumont Hospitals, is
intimately involved in both issues on several
levels.
She's an Ashkenazi Jew, among whom an
increased risk for the mutation that causes
breast and/or ovarian cancer appears in 1
in 40 women as compared to 1 in 800 in the
general population.
Her grandmother, for whom she is
named, died in the Holocaust, so her fam-
ily has limited knowledge of their medical
history.
And, "For an oncologist who treats people
once they have cancer, nothing is more
exciting and inspiring than to be able to
offer prevention for patients': she said.

On The Radar

Gene testing is a hot topic, coinciding with
September, Ovarian Cancer Awareness
Month, and October, Breast Cancer
Awareness Month. Major stories recently
appeared in the Wall Street Journal and the
New York Times.
The Journal's Sept. 11 piece discussed the
pros and cons of a new direct-to-consumer
advertising campaign by Myriad Genetic
Laboratories, Inc. aimed at promoting
awareness and use of the test — which it
developed and patented — to women. "We
are confident that our materials represent
the highest quality of information;' Gregory
Critchfield, president of Myriad, told the
Journal.
The Times' Sept. 16 front-page story con-
centrated on a Chicago medical student's
agonizing path to a prophylactic double
mastectomy after a breast cancer gene test
confirmed she carried a mutation that has
produced a family history of cancer.
"I don't think you need to be tested
just because you're Ashkenazi Jewish':
said Zakalik, a Birmingham wife and
mother of two, who helped start the cancer

Dr. Dana Zakalik: "For an oncologist who treats people once they have cancer, noth-
ing is more exciting and inspiring than to be able to offer prevention for patients."

FAMILY TREE

Grandfather Grandmother

Grandfather Grandmother

Europe, primarily Germany, Poland and
Russia.

By The Numbers

Aunt

Father

Sister

W

Mother

Brother

Uncle

YOU

Persons diagnosed with cancer

Source: Karmanos Cancer Institute, Detroit

genetics program at Beaumont in 2004.
"Approximately a third of all women have
a family history of breast cancer. It doesn't
mean they have the gene
But, in an Ashkenazi family where there is
"even one case of breast or ovarian cancer,
we have an opportunity to prevent it," she
said.
Ashkenazi refers to people from Eastern

Nationally, about 200,000 women (and
1,500 men) develop breast cancer each year,
according to the Centers for Disease Control
and Prevention. During the same period,
about 23,000 women develop ovarian can-
cer.
"About 5-10 percent of these cancers
may be hereditary or due to a damaged (or
mutant) gene that is passed down from
parent to child': Zakalik said. And, certain
aspects of a person's family history may
indicate an inherited cancer predisposition.
"Identifying these aspects allows us to
assess an individual's risk of having a cancer
predisposition mutation': Zakalik said.
Those who test positive have as high as an
87 percent chance of having breast cancer in
their life time and about a 40 percent chance
of having ovarian cancer.
"It's important for people to know that it
doesn't skip a generation': Zakalik said.

That translates positively as well as nega-
tively. If your mother tests positive for the
gene, but you test negative, you can't pass it
on.
The genes, BRCA1 and BRCA2 are the
culprits. Three types of tests are designed
to look for their mutations, according to
Myriad. What is known as the Mutisite 3
BRACAnalysis probes the three most com-
mon BRCA1 and BRCA2 mutations in
people of Ashkenazi Jewish descent.

Coverage Costs

Genetic tests cost from $385 to $3,200
depending on the specific gene(s) being
tested and if there is a known familial muta-
tion. Insurance generally pays all or most of
the cost of testing for those who meet the
criteria (see related Cancer Risk Checklist),
Zakalik said.
"The average patient pays only 10 percent
of the test price out-of-pocket': Myriad said.
Although most have been diagnosed with

Gene Alert on page 44

October 4 • 2007

43