"Usually the flags aren't so red," said Dr. Bongi Rudder, an oncologist at Sanford Aberdeen Medical Center.
Hereditary breast cancers account for anywhere from 5 to 15 percent of breast cancer cases.
The usual cases in which Rudder considers a hereditary basis for cancer are when:
- A younger patient has cancer.
- There is a family history of cancer. This applies to primary and secondary relatives, and age at the time of diagnosis is taken into account.
- There are family members who get particular combinations of cancers. For instance, breast and ovarian cancer can be linked to the same gene.
Rudder refers those patients to a genetic counselor. Most insurance companies cover testing, which can cost about $4,000, when there is a basis for the testing, she said.
Angelina Jolie's decision to have preventive surgery brought the issue into mainstream pop culture. Rudder said it's good that it brought awareness of BRCA testing, but patients should know there are other options and it's up to them to decide.
Other methods for prevention include chemo-prevention by taking certain medicines to help prevent breast or ovarian cancers or just to be careful with additional screening.
Rudder encourages those who have questions to look into their family history and raise questions with their doctor. Insurance companies have been receptive to testing since having the genes increases the likelihood of developing cancer so greatly.
"In the long term, that's health and cost-effective," Rudder said.