Genetic counseling is recommended in women whose personal or family health history suggests a greater than average likelihood of a<unk> . The purpose of genetic counseling is to educate the person about the likelihood of a positive result, the risks and benefits of being tested, the limitations of the tests, the practical meaning of the results, and the risk-reducing actions that could be taken if the results are positive. They are also trained to support people through any emotional reactions and to be a neutral person who helps the client make his or her own decision in an informed consent model, without pushing the client to do what the counselor might do. Because the knowledge of a<unk>  can produce substantial anxiety, some people choose not to be tested or to postpone testing until a later date. Relative indications for testing for a<unk>  in<unk> 1 or<unk> 2 for newly diagnosed or family members include a family history among 1st (FDR), 2nd (SDR), or 3rd(TDR) degree relatives usually on the same side of the family but not limited: * A known<unk>  <unk> 1 or<unk> 2) in a cancer susceptibility gene within the family * Women affected with any breast cancer diagnosed under the age of 30 * Women affected with triple negative breast cancer (TNBC) (estrogen receptor negative, progesterone receptor negative, and HER2/neu negative) under the age of 50 * Two relatives (FDR/SDR) diagnosed under the age of 45 * Three relatives (FDR/SDR) diagnosed with average age of 50 or less * Four relatives at any ages * Ovarian cancer with either an additional diagnosed relative or a relative with male breast cancer * A single family member with both breast and ovarian cancer * Male breast cancer * Pancreatic cancer with breast or ovarian cancer in the same individual or on the same side of the family * Ashkenazi Jewish or Polish ancestry with one FDR family member affected by breast or ovarian cancer at any age Testing young children is considered medically unethical because the test results would not change the way the child's health is cared for. Test procedure Two types of tests are available. Both commonly use a blood sample, although testing can be done on saliva. The quickest, simplest, and lowest cost test uses positive test results from a blood relative and checks only for the single<unk>  that is known to be present in the family. If no relative has previously disclosed positive test results, then a full test that checks the entire sequence of both<unk> 1 and<unk> 2 can be performed. In some cases, because of the founder effect, Jewish ethnicity can be used to narrow the testing to quickly check for the three most common<unk> s seen among Ashkenazi Jews. Testing is commonly covered by health insurance and public healthcare programs for people at high risk for having a<unk> , and not covered for people at low risk. The purpose of limiting the testing to high-risk people is to increase the likelihood that the person will receive a meaningful, actionable result from the test, rather than identifying a variant of unknown significance (VUS). In Canada, people who demonstrate their high-risk status by meeting specified guidelines are referred initially to a specialized program for hereditary cancers, and, if they choose to be tested, the cost of the test is fully covered. In the US in 2010, single-site testing had a retail cost of US$400 to $500, and full-length analysis cost about $3,000 per gene, and the costs were commonly covered by private health insurance for people deemed to be at high risk. The test is ordered by a physician, usually an oncologist, and the results are always returned to the physician, rather than directly to the patient. How quickly results are returned depends on the test—single-site analysis requires less lab time—and on the infrastructure in place. In the US, test results are commonly returned within one to several weeks; in Canada, patients commonly wait for eight to ten months for test results. Test interpretation A positive test result for a known deleterious<unk>  is proof of a predisposition, although it does not guarantee that the person will develop any type of cancer. A negative test result, if a specific<unk>  is known to be present in the family, shows that the person does not have a<unk> -related predisposition for cancer, although it does not guarantee that the person will not develop a non-hereditary case of cancer. By itself, a negative test result does not mean that the patient has no hereditary predisposition for breast or ovarian cancer. The family may have some other genetic predisposition for cancer, involving some other gene.
BRCA mutation
History of radiation therapy
Chromosomal fragile site
Radiation exposure
Human papillomavirus infection
SAMPLE history
Dichromacy
ALPSA lesion