Testing at Tri-City hospitals gives early look at cancer risk

Wendy Gilbert was nervous. So nervous.

It had been about a month since she'd provided DNA to be tested for a gene mutation that would mean she had a greatly elevated risk of breast and ovarian cancer.

She'd taken a swig of Scope, swished it around in her mouth and then spit it back out into a tube to be sent off for analysis.

And she was about to learn the results.

Her face felt warm. Her heart beat a mile a minute. She clutched her daughter's hand.

Mercifully, Rachel Gorham, the Trios Health nurse practitioner who arranged the test, cut right to the chase last week.

"You do not have the mutation. It's good news," she told Gilbert.

Gilbert, 58, of Pasco, let out a cheer. She wrapped her daughter in a hug.

She smiled -- a wide, joyful smile.

Gilbert had breast cancer 14 years ago. Her mother also battled -- and beat -- the disease. That personal and family history made her feel pretty certain she would test positive, and it made her worry for her kids, whose chances of having the same faulty gene would be at 50 percent.

Learning she was negative was a relief -- the news she wanted to hear, Gilbert said. But she did the test so she'd know either way, so -- if she was positive -- she could be proactive and pass on the important health information to her kids, she said.

Gorham, based at Trios' deBit building, regularly screens and tests patients for mutations of the BRCA 1 and BRCA 2 genes. Those genes produce proteins that suppress tumors, and inherited mutations can bring the risk of developing breast cancer to 87 percent and ovarian cancer to 44 percent by age 70. By comparison, the risk is 8 percent for breast cancer and less than 1 percent for ovarian cancer for the general population.

The American Cancer Society estimates that about 232,670 new cases of invasive breast cancer will be diagnosed this year in women in the U.S., along with about 62,570 new cases of a noninvasive early form of breast cancer and 21,980 new ovarian cancer cases.

Breast cancer is the second-deadliest cancer in women, and ovarian cancer is the fifth, according to information from the group.

When a BRCA test comes back positive, Gorham helps patients understand their options, which range from increasing surveillance to preventive surgery. Actress Angelina Jolie famously opted for a double mastectomy after she tested positive for a BRCA 1 mutation.

At Gilbert's appointment, her daughter Haliey, 21, provided moral support. And she shared in her mother's relief -- for her mom and herself.

"I'm kind of in shock right now. My whole life, I've had the knowledge in the back of my head that I probably would have breast cancer one day," Haliey said.

She understands she's still at greater risk than the general population because of her family history, "but it's comforting to know that there's kind of a blanket of security a little bit."

Gilbert also has a 23-year-old son, Brandon. Had his mother tested positive, Gorham would have advised that he also be tested. Men can inherit a BRCA mutation, putting them at increased risk for breast cancer and some other kinds of cancer.

Gorham screens all her patients at every visit to see if they meet the criteria -- which is largely based on family cancer history -- for a BRCA test. And every women who has a mammogram through Trios Health also is screened.

Gorham works with the company Myriad Genetics -- she's a speaker and she trains other providers -- and is its leading BRCA test provider in the Northwest, she said.

The test can be spendy, but Gorham said most insurance companies fully cover it, and Myriad also will cover testing for patients without insurance. Virtually all her patients -- about 95 percent -- haven't paid anything for the test, Gorham told the Herald.

Gorham sees the test as empowering.

"A lot of women have a family history of breast cancer, and they don't know what to do with it. It hangs over their head, it hangs on their shoulders. They don't know there's anything they can do about it," she said. But the test provides knowledge, and "knowledge is power," she said.

In the exam room last week, Gorham told Wendy that she'll need to start having a breast MRI in addition to her yearly mammogram because of her family history. Haliey will need to be extra vigilant.

But it was clear a weight had been lifted. As the news of the results sank in, mother and daughter asked a few questions. They reflected.

They said they were going out for ice cream -- they'd planned to anyway, but with the negative test results it would be a celebration.

Gilbert had been anxious about the test "since the day I spit," she said. But "I'm in God's hands. It's God's journey I'm on, not mine."

Every year when she goes in for a mammogram, she worries about another cancer diagnosis. But now, with the knowledge she doesn't have a BRCA mutation, perhaps she'll feel a little lighter, she said. Perhaps it will be a little easier.

Gilbert wants women to know the test process is simple, she said. They may be nervous, but "don't (avoid) something because you're scared."

In her view, "it's better to know than not to know."

This story was originally published August 23, 2014 at 9:35 PM with the headline "Testing at Tri-City hospitals gives early look at cancer risk ."