Hereditary Breast and Ovarian Cancer (HBOC) syndrome is an inherited genetic condition characterized by increased risk for breast, ovarian, prostate, and pancreatic cancers. Melanoma and other cancers may also be associated. Genetic counseling and testing can help individuals learn more about their cancer risk, as well as their options for screening and risk reduction. Approximately 10 percent of all cancer is thought to be hereditary, and at least 15 percent of ovarian cancer is suspected to be hereditary.

Per NCCN Guidelines, anyone with the following risk factors in their personal or family history should consider seeing a certified genetic counselor to learn more about their risks and potentially develop a genetic testing plan:

  • History of one of the following at any age:
    • ovarian cancer
    • pancreatic cancer
    • metastatic prostate cancer
    • male breast cancer
  • Individual with breast cancer and the following:
    • Ashkenazi Jewish ancestry
    • diagnosis of breast cancer at or before age 45
    • triple negative breast cancer at or before age 60
    • close relative with history of breast cancer at or before age 50, ovarian cancer, pancreatic cancer, or metastatic prostate cancer
    • two close relatives with breast cancer at any age
    • diagnosis of breast cancer at age 46-50 with:
      • a second breast cancer
      • close relative with history of breast, ovarian, pancreatic, or prostate cancer at any age
      • limited or unknown family history
  • Individual with prostate cancer and the following:
    • Ashkenazi Jewish ancestry
    • metastatic prostate cancer
    • close relative with history of breast cancer at or before age 50, ovarian cancer, pancreatic cancer, or metastatic prostate cancer
    • two close relatives with prostate or breast cancer at any age
  • Other risk factors:
    • Known pathogenic BRCA 1/2 variant (mutation) in the family
    • A pathogenic BRCA1/2 variant found on genetic testing of a tumor sample (somatic variant)

If someone does not meet the above criteria for genetic counseling themselves but a close relative does, genetic counseling may still be appropriate. A genetic counselor can determine whether genetic testing is needed and who in the family should be tested first.

BRCA status may affect cancer treatment decisions and should be discussed with healthcare providers. Examples of how a genetic finding might impact medical management include:

  • BRCA+ women with ovarian cancer, especially recurrent ovarian cancer, may be more likely to be offered a medication called a PARP inhibitor.
  • BRCA+ women with metastatic HER2-negative breast cancer may qualify for a PARP inhibitor.
  • BRCA+ men with prostate cancer may be considered for early use of platinum chemotherapy or be eligible for clinical trials.
  • Any BRCA+ individual with pancreatic cancer whose cancer did not grow or spread during the first platinum-based chemotherapy may be eligible to use a PARP inhibitor as maintenance therapy.

The risk factors listed above should not be used exclusively to determine candidates for genetic counseling. There are other factors that should be evaluated when determining a person’s risk, such as family size, number of female relatives, preventive breast and gynecologic surgeries, and adoption status. The above risk factors pertain to HBOC syndrome only. For a full assessment, risk factors for other hereditary cancer syndromes should be evaluated.

Insurance coverage for testing varies, and preauthorization is often performed after a detailed personal and family history is obtained.

This article was originally published on September 24, 2020.