Though these genetic mutations have most notably been associated with breast cancer, research has shown that they increase the risk for other cancers, too — including pancreatic cancer. According to PanCAN, BRCA genes help repair DNA damage; when these genes are mutated, “the accumulation of unrepaired DNA damage can ultimately lead to unregulated cell growth, or cancer,” says Allison Rosenzweig, PhD. These mutations are not common in people with pancreatic cancer. “If you looked at 100 patients with pancreatic adenocarcinoma, about two to three of those would have a BRCA mutation,” says Robert Pilarski, master of social work, a licensed genetic counselor and a clinical associate professor in human genetics at The Ohio State Wexner Medical Center in Columbus. But it’s important for all people diagnosed with pancreatic cancer to get tested for BRCA and other mutations, because these hereditary genetic mutations will have a few ramifications for your treatment, your future, and the future health of your family, too. RELATED: Managing EPI in Pancreatic Cancer
Why BRCA Mutations and Treatment
Having a BRCA Mutation may well help inform your treatment. There are a couple categories of chemotherapy that are prescribed based on genetics, rather than simply the fact you have a tumor, says Pilarski. One is PARP inhibitors, a type of targeted therapy that blocks the PARP enzyme, inducing the death of cancer cells, according to the National Cancer Institute. Lynparza (olaparib), a drug approved by the U.S. Food and Drug Administration at the end of 2019 for the treatment of pancreatic cancer for those with BRCA mutations, is one example. Another PARP inhibitor is Rubraca (rucaparib), which has been found to be an effective maintenance therapy for these types of cancers, according to a study published in April 2019 in Cancer Discovery. These drugs have been shown to be more easily tolerated than the traditional chemotherapy regimen used for this disease, Folfirinox, and they also result in extended survival. RELATED: In Less Than a Six-Month Span, My Father Was Diagnosed With — and Cured of — Pancreatic Cancer
BRCA Mutations in the Family
What’s more, along with pancreatic cancer and breast cancer, BRCA mutations elevate one’s risk for breast, ovarian, and prostate cancer. This can change how you and other first-degree relatives (that’s a parent, sibling, or child) are screened for other cancers, says Pilarski. For instance, men who carry a BRCA mutation would begin prostate cancer screening at age 40. Women begin receiving breast magnetic resonance imaging scans (MRIs) as early as age 25. “These screenings are done earlier and much more aggressively,” he says. For women and their relatives who have a BRCA mutation, preventive surgery to remove the ovaries is often recommended. RELATED: My Genetic Test Came Back BRCA Positive — Here’s How I’m Coping
Testing — and Its Implications
If you’re diagnosed with a pancreatic adenocarcinoma, you should have a genetic testing panel done, says Pilarski. The panel will pick up not only BRCA1 and BRCA2 mutations, but other, less common genes that may contribute to risk. Studies show, in fact, that anywhere from 3.8 to 11.5 percent of patients will have some type of gene mutation that may alter therapy decisions, noted a paper authored by Pilarski published in May 2019 in the journal American Society of Clinical Oncology Educational Book. One caveat: This type of specific genetic testing applies only to pancreatic adenocarcinomas, the most common type of pancreatic cancer, which affects 9 out of 10 of pancreatic cancer patients, according to the Pancreatic Cancer Action Network (PanCAN). This recommendation does not apply if you have a pancreatic neuroendocrine tumor (PNET), a rarer type of pancreatic cancer not associated with genetic mutations. And a piece of advice: If you’re not offered genetic testing, ask. Genetic testing is much more likely to happen if you’re being treated at a large cancer center. If it’s not brought up, ask your treatment team about it. “The recommendation to test patients has just solidified in the last year or so, and so it may take a while to be adopted everywhere,” says Pilarski. If the genetic panel is positive for a mutation, then your center should also arrange testing for other family members. If they’re not local, the center should help connect them with genetics programs in other parts of the country, says Pilarski. Knowing your family history is key. If you have or had a first-degree relative with a pancreatic adenocarcinoma, you may also want to get genetic testing yourself. Talk to your doctor about what the best option is for you. A genetic counselor can help you work through all of this both before testing (to walk you through the process and prepare you for potential outcomes) and after (to interpret what can be very complex results). “In an ideal world, we’d have the [close] family members there. But in the real world, we often talk to a patient and their spouse. In that case, we make them aware of what the downstream implications could be for their family,” says Pilarski. Working with a counselor can help you sort out your risk, best process the implications, and set out a plan so you can get the best care possible. RELATED: What to Know Before You Buy an At-Home Genetic Cancer Risk Test
