Jolie jolt? Go for genetic counseling first

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Angelina Jolie

NEW DELHI: Call it paranoia or genuine anxiety. After Angelina Jolie went in for a double mastectomy, many in India are making a beeline for genetic tests, irrespective of whether they are at risk or not. But doctors warn that only few have a sufficiently strong family history of cancer to justify this testing. What’s more important is to undergo genetic counseling.

At HCG Cancer Center, Bangalore, more than 150 queries have been received for genetic testing since Jolie’s case came to light. While 26 have undergone the test this year, in 2012, 52 did so. At Max Hospital, Delhi, 1-2 cases are coming every day for testing since Jolie’s case, says Dr Amit Verma, molecular oncologist.

While a lot of hullabaloo was raised over the star’s surgery, it’s more important to prevent cancer through genetic counseling and testing, which is a fast expanding medical specialty, says Dr Sunil Kumar Gupta, senior consultant, medical oncology, Rajiv Gandhi Cancer Institute, Delhi. “Even if a person already has, say breast cancer, gene testing can help predict cancer in the other breast and other related cancers like ovarian cancer. It also increases the probability of cancer of the colon, pancreas, prostrate and skin.”

Counseling also reveals the probability of the patient’s children inheriting cancer genes, says Dr Radheshyam Naik, consultant, medical oncologist, HCG, Bangalore. “While breast cancer normally affects 1 in 20 women, if one parent has cancer, the chances will be 1 in 10, but if both parents have it, it will be 1 in 5.”

Genetic counseling involves gathering and interpreting information about at least three generations of family history. Patients are stratified into average/moderate/high-risk categories and only then are various investigations and treatment options offered. Genetic testing for cancer is done via a blood test and there are a dozen parameters to be checked. It costs between Rs 65,000-75,000 and takes about 15 days. Most hospitals send the samples abroad for testing.

If positive, the patient is put on medicines such as Tamoxifen (for breast cancer) and Finasteride and Dutasteride (for prostate cancer). However, not all cancers are caused by BRCA1 or BRCA2 gene mutations. There are also CDH1 gene mutations which cause gastric cancer. With some 40,000 genes in every cell, chances of mutation are always there.

Statistics reveal that out of every 100 cancer cases, 10 are hereditary. And contrary to what some experts say, hereditary cancer can’t be prevented through lifestyle choices such as vitamin D supplementation, juices and superfoods. “Mutations in cancer are inherited, so how would a lifestyle choice remove them,” asks Verma.

But it’s important to do the tests only if the probability is high. “A negative test does not mean a negative result and a positive test does not mean a death knell,” says Verma. That’s why it is essential, says Gupta, to have standardisation of these tests and certified labs in India. “It’s important to interpret the tests correctly and advise patients to change their daily lives accordingly,” he says.

And quit worrying, advise doctors, as stress too can cause cancer.


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