BRCAvantage^®, Rearrangements

When BRCA-related breast and/or ovarian cancer syndrome is suspected and no BRCA1 or BRCA2 mutation testing has been performed, consider ordering the BRCAvantage®, Comprehensive test (test code 91863).

For individuals of Ashkenazi (Eastern European) Jewish heritage, consider ordering the BRCAvantage®, Ashkenazi Jewish Screen (test code 91864) as the first line test, Full sequencing may be considered if ancestry also includes non-Ashkenazi Jewish relatives or if other clinical criteria for BRCA-related breast and/or ovarian cancer syndrome are met. For this scenario, consider BRCAvantage^®, Ashkenazi Jewish Screen with Reflex BRCAvantage^®, Comprehensive (test code 92140).

If a familial mutation has been detected by sequencing or deletion/duplication studies, the BRCAvantage^®, Single Site test (test code 91865) should be considered. Official test results of the family member must be available for laboratory review.

Additional tests are available to assess the risk of hereditary breast cancer. Please refer to the BRCAvantage^® Plus™ Test Menu FAQ for a description of test codes 92587, 92573 and 92586, or refer to the Hereditary Cancer Test Selection Guide.

The National Comprehensive Cancer Network (NCCN) has guidelines for BRCA1 and BRCA2 mutation testing (http://www.nccn.org). The guidelines strongly recommend genetic counseling for the patient before ordering this test. Generally, individuals with a personal diagnosis of early onset (≤50 years) breast cancer, bilateral breast cancer, and/or ovarian cancer and/or a strong family history of breast and/or ovarian cancer are appropriate for BRCAvantage^®, Comprehensive testing. The person in the family with the strongest indication of hereditary cancer, such as the person with earliest diagnosis of breast or ovarian cancer, should be tested first whenever possible.

For more information or to discuss a family history with a Quest Diagnostics genetic counselor, please call Quest Genomics Client Services at 866-GENE-INFO.

If your patient tests positive for a pathogenic or likely pathogenic BRCA1 or BRCA2 deletion, duplication, or rearrangement, he/she is at significantly increased risk for developing breast and ovarian cancer and other BRCA1/BRCA2-related cancers compared to the general population.

NCCN provides up-to-date surveillance and management recommendations for mutation carriers (http://www.nccn.org). Referral to an oncology center experienced in treating patients with a BRCA1 or BRCA2 mutation might be considered to discuss options. These options include increased surveillance, chemoprevention, and prophylactic surgery.

Patient previously diagnosed with breast or ovarian cancer:

No rearrangement was found. Your patient’s risk of recurrence or a related new cancer is based on his/her personal and family histories of cancer. In some instances, it may be appropriate to test for other hereditary forms of cancer. Please call Quest Genomics Client Services at 866-GENE-INFO to discuss possible additional studies with a genetic counselor.

Patient not previously diagnosed with breast or ovarian cancer, but with a family history of breast and/or ovarian cancer:

No rearrangement was found. Testing an affected family member is recommended for proper risk assessment. Your patient’s risk of cancer is based on his/her personal and family histories of cancer. In some instances, it may be appropriate to test for other hereditary forms of cancer. Call Quest Genomics Client Services at 866-GENE-INFO to discuss possible further studies.