Dear Dr. Roach: The answer to J.P. needs to address the strong family history of breast cancer. She should be referred to a genetic counselor to determine whether she needs to be screened for BRCA I or II.
Dear J.T.: J.P. wrote in December about the safety of vaginal estrogen, and noted that she’d had “a grandmother, aunt, sister (both breasts) and now a first cousin with breast cancer.”
It indeed sounds like her family history would qualify her as having an increased risk for developing breast or ovarian cancer associated with BRCA1 or BRCA2 mutations. The United States Preventive Services Task Force has recommended genetic counseling for women at increased genetic risk.
There are several benefits from testing for BRCA status. The results allow the physician to better estimate risk for future breast and ovarian cancers, which in turn can inform the decision as to medication or surgery to reduce risk of breast cancer. Secondly, the information can be of benefit to family members. Thirdly, knowing the results can reduce anxiety.
Potential harms of genetic testing need to be considered. The USPSTF says: “Routine referral for genetic counseling and consideration of BRCA1 and BRCA2 testing clearly has important psychological, ethical, legal, and social implications, although they are not well quantified in the literature.”
The younger one is, the greater the personal benefit to knowing genetic risk. However, even for an older person, it may be worthwhile to know their genetic risk, especially for family members.
Dear Dr. Roach: Would someone who has a gluten intolerance be able to use psyllium products (Metamucil) without any problems? What I really want to know is, does psyllium have gluten, since it comes from wheat husks? Thank you for your answer.
Dear S.S.: Psyllium is gluten-free. It is made from the husks of the Plantago plant, not wheat. Psyllium is an excellent source of fiber, but should be started at a low dose and gradually increased to avoid bloating.
Email questions to ToYourGoodHealth@med.cornell.edu.