One Nevada Bill Aims To Increase Genetic Screenings For Breast Cancer
Earlier this week, the Nevada Senate passed a bipartisan bill that could make a particular genetic screening for women’s health, a state law. KUNR’s Lucia Starbuck has the details.
The US Preventive Services Task Force is a medical group of experts that issues clinical guidelines on the standards of care.
For example, they advise providers, essentially requiring them to ensure women have access to counseling and screening for a BRCA1 or BRCA2 gene mutation. If women inherit a mutation, they have an elevated risk for several cancers, particularly breast and ovarian cancer.
Republican State Senator Heidi Gansert is a co-sponsor of Senate Bill 251, which closely mirrors federal recommendations.
“When you go see your health practitioner, and it doesn’t matter if it’s a physician, or a nurse practitioner, or a physician assistant, that person should do an assessment to determine whether you have the likelihood of having a BRCA gene,” Gansert said.
The bill aims to provide Nevadans an extra layer of protection in case there are changes at the federal level. Current guidelines require health care providers to assess women to determine if they’re high risk, and if they are, insurance coverage for genetic counseling and testing.
“Given the negative outcomes if you are diagnosed with BRCA1 and 2, and the importance of getting diagnosed earlier, we just thought we really wanted to put it in state law,” Gansert said.
Roughly 1 in every 500 women in the United States has either a BRCA1 or 2 mutation, according to the Centers for Disease Control and Prevention (CDC). The risk factors are a personal or family history of cancers. Also, those who have a higher likelihood of carrying the mutation including Ashkenazi Jewish women.
If passed, this bill will require clinicians to provide genetic screening information for women with these risk factors through a written notice provided with their mammogram results.
Gansert said that early detection can be critical.
“My sister-in-law, she had her first cancer when she was 30 years old and wasn’t diagnosed to be BRCA positive ‘till she was 60. And my friend who died last year, she had cancer over a 25-year period. It was not diagnosed with the genetic mutations until the last, roughly, five years. Both her daughters and all their cousins were positive,” Gansert said.
Gansert was galvanized to sponsor a bill to protect Nevadans when she learned yet another one of her friends, Abbi Whitaker, also has a BRCA mutation. Whitaker is a Reno resident and cancer survivor.
Ten years ago, in her mid-thirties, Whitaker was diagnosed with anal cancer caused by human papillomavirus (HPV). After grueling rounds of chemo and radiation, she’s now in remission.
“I found it early and was able to treat it aggressively,” Whitaker said.
Last year, Whitaker went in for a mammogram and completed a questionnaire, which indicated she might be at high risk for a BRCA mutation.
As a busy mom of two, running her own public relations firm, Whitaker didn’t act on this immediately until, “When I got the letter in the mail and I saw BRCA2 jump out. I knew what that was. And I’m like, ‘Oh God, you got to call those people back,’” Whitaker said.
And that notification got to her.
“When I had cancer 10 years ago, I was afraid of not seeing my daughter grow up, or my son, watching them get married. It was so scary. And the worst part about cancer for me, the treatment sucked, but like the five years afterward, every time I hurt, I was so scared that it was going to come back and I was going to die,” Whitaker said.
After getting tested, Whitaker learned she had the BRCA2 variant, which increases a woman’s risk of breast cancer by 45 to 69%, according to the National Cancer Institute.
To reduce her risk, she opted to get a preventative double mastectomy.
“It wasn’t even a question because I don’t want to wait until I have cancer and I don’t want to live in fear because I want to live my life,” Whitaker said.
Health care providers say mastectomies aren’t the only option to prevent breast cancer, and may not be the best course of action for everyone.
But for Whitaker, this choice felt right because of her family’s history.
"My grandmother died of cancer. Her sister died of cancer. My other aunt had a double mastectomy. My auntie Denny has had cancer twice. It’s because of BRCA, but they didn’t know, like they didn't know to tell me, they didn't know they’re BRCA,” Whitaker said.
There is a 50% chance that a parent can pass down the variant. Dr. Nathan Slotnick is a medical geneticist based in Reno. He said other family members can also be at risk.
“There are six other family members at risk as well for the average BRCA positive patient,” Slotnick said.
But he said the number of family members affected can vary based on their family size.
Slotnick testified in support of the bill. He said genetic testing for BRCA is one option to prevent cancer. He’d like to see medical providers get more training on genetic screening. The bill does have a provision for provider education.
The federal recommendations for BRCA genetic testing aren’t without controversy. Some say the prerequisites used to assess if someone is high-risk are too limited and might overlook some patients. And others argue that routine risk assessments may lead to unnecessary care for others.
What SB251 aims to achieve is for patients to have as much information as possible to make decisions about their health.
“It’s empowering, not only do you find out what your risks really are, but it allows you to initiate a program of surveillance and be proactive about your health,” Slotnick said.
Senate Bill 251 is co-sponsored by a total of nine female lawmakers on both sides of the aisle. It passed out of the Senate unanimously and will next head to the assembly for a vote.