ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. Monika Sharda: Hi, I'm Monika Sharda, an editor at Cancer.Net, and your host for today's podcast. In this episode, we will discuss genetic testing for hereditary cancers. Our guest is Dr. Allison Kurian, a medical oncologist at Stanford University. She is also the Director of the Stanford Women's Cancer Genetics Clinic and serves as a Specialty Editor for Cancer.Net. Welcome, Dr. Kurian. Dr. Kurian: Thank you so much for having me. Monika Sharda: Dr. Kurian co-authored a recent study in the Journal of Clinical Oncology about genetic testing among breast cancer and ovarian cancer patients. Before we get into talking about the study, tell us about genetics and the role they play in cancer risk. What does it mean to have an inherited risk for cancer? Dr. Kurian: Yes, that's a great question. And we've learned so much about it in recent decades really picking up the pace the last five years or so. What it typically means is that a person has inherited a genetic change from one of her parents. And I'm going to say “her” because it's mostly women we'll be talking about today, though it is the same in men when they inherit a change. And so she would have inherited a change in a gene that normally works to keep cancer cells from accumulating, to keep cancerous changes from growing in cells. And so when that happens, she often would be at higher risk than other people of ultimately developing a cancer. It doesn't mean that she definitely will, but it means that her risk is higher. Often two to five times higher. Monika Sharda: So what does genetic testing for breast and ovarian cancers tell us? Dr. Kurian: So what we do when we do genetic testing is it's generally first we would need to counsel a patient about her options and if she chooses to do genetic testing it would be a blood or a saliva test where we would sequence genes that are known to be implicated in maintaining a normal cell that doesn't turn into a cancer cell. And so we know from studies over the last few decades, that in patients who are born with an abnormality in one of these genes that their cancer rate is much higher than others. And so over the last 20 years, 25 years now, starting in 1994 and 1995 we've been testing primarily for two genes: BRCA 1 and BRCA 2. But over the last 5 to 6 years we've had the ability to test for many more genes and find many more patients who have an increased risk. Monika Sharda: Based on existing guidelines who should receive genetic testing for these cancers? Dr. Kurian: So that's a very timely question and I'll keep it simple, but I will just say that we're in the throes of a bit of a controversy in terms of what different guidelines are saying. I'm going to give you sort of the standard set of guidelines, which is to say that for breast cancer, it tends to be based on criteria like being diagnosed at a young age which usually means being diagnosed under age 50 or under age 45. It will be based on characteristics like having an unusual type of breast cancer: triple negative, or hormone-negative breast cancer is such a kind. Or having a strong family history, relatives with breast or ovarian cancer. That's the standard most would say for who should receive breast cancer testing. For ovar