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April 21, 1993

Genetic Counseling for Families With Inherited Susceptibility to Breast and Ovarian Cancer

Author Affiliations

From the Departments of Human Genetics (Ms Biesecker and Dr Collins) and Internal Medicine (Mss Biesecker, Markel, and Calzone and Drs Collins and Weber), University of Michigan School of Medicine, Ann Arbor; University of Michigan Human Genome Center (Mss Biesecker and Markel and Drs Boehnke and Collins); Department of Biostatistics (Dr Boehnke), University of Michigan School of Public Health; Howard Hughes Medical Institute (Dr Collins), Ann Arbor, Mich; and Dana Farber Cancer Institute (Dr Garber), Boston, Mass

JAMA. 1993;269(15):1970-1974. doi:10.1001/jama.1993.03500150082032

Efforts are under way to isolate a gene (BRCA1) on chromosome 17q12-21. Mutations in this gene predispose women to breast and ovarian cancer. Women with germline mutations in BRCA1 are estimated to have an 85% lifetime risk of developing breast cancer and an increased but as yet undetermined risk of ovarian cancer. It is estimated that one in 200 to 400 American women may be carriers of BRCA1 mutations. We have identified several families that show linkage between breast and/or ovarian cancer and genetic markers that flank BRCA1. It is now possible, within these linked families, to prospectively identify family members likely to be carrying BRCA1 mutations. Because of profound and immediate clinical ramifications, we offered to provide this information to one such extended family. To provide information to this family, we developed a protocol to address the many issues that arise in the delivery of these services. Although testing for BRCA1 mutation carriers is currently limited to very rare families being analyzed for research purposes, this experience presages the complexities of the much larger scale availability of population screening for BRCA1 mutations, which is likely to become a reality in the next few years.

(JAMA. 1993;269:1970-1974)