Scott Webb (Host): Genetics and a family history of certain cancers can play a big role in being screened earlier for cancers and also treatment plans for patients who've been diagnosed with cancer. And joining me today is Arlie Button. She's a Certified Genetic Counselor with Carle. Arlie, it's nice to have you here today.

We're talking genetics and genetic counseling at Carle Health and what does that mean exactly? So great to have you here. Just want to start out by having you address the hereditary nature, if you will, of prostate cancer. I think I read somewhere. It's about 10%, but from your perspective as an expert.

Arlene Button, MS, CGC: Yeah, so you're right, 10% of prostate cancer is hereditary, so the vast majority of it is due to our environment, what we're exposed to over time. And thinking about like our eating habits, smoking, drinking, viruses, you know, these sorts of things that we think about with environmental cancer. But 10% is hereditary, which makes it as hereditary as breast cancer, even though we don't think about it that way, sometimes. It's even more hereditary than uterine cancer or colon cancer. And there are probably six or seven different genetic mutations in six or seven genes that cause prostate cancer, increased risk for prostate cancer.

Host: Okay. Yeah. So as you say, there's, the family history, genetics involved, behavior, lifestyle, the, you know, greatest hits if you will. Maybe you can share, you know, men with prostate cancer and a family history of breast, pancreatic, ovarian, colon, uterine; they need to be referred, right? That list there, if you have a family history of any of those cancers, that's a good time to be referred for genetic counseling, right?

Arlene Button, MS, CGC: Right. Yeah. So the two major genes that cause hereditary prostate cancer are the same genes we think about for hereditary breast cancer or hereditary ovarian cancer. Hereditary pancreatic cancer. They're BRCA1 and BRCA2. So if you're seeing a family that it looks like it could be BRCA family, you know, because there's early breast cancer or a woman getting multiple cases of breast cancer, or someone had ovarian cancer. Someone had pancreatic cancer. There are a couple prostate cancers in the family. That's a good family to refer. So a lot of times patients who come to me, they're female, right? Because the, it's the women who were asking questions about, oh, do you have, you know, a mother who had breast cancer? But, men also have mothers who have breast cancer and they should be referred as well because some of those men are going to have mutations in BRCA1 and 2 for instance, have that higher risk of prostate cancer, and would benefit from increased screening. So yeah, not just the men who have prostate cancer who need to be referred, but also the men who could be at risk for prostate cancer because of what we're seeing in their family history.

Host: Yeah, and you've mentioned there about men versus women and who's being referred and who you're seeing in the office, and it made me think, you know, and this is anecdotal at best, but I feel like men are under referred and under tested, and I'm including myself, in that group, of course. So maybe you could talk about that because as, as I read, at least half the people in the world with the BRCA mutation are men.

But if they are in fact being under referred and under tested, why is that and how do we encourage them to come see you?

Arlene Button, MS, CGC: Yeah, so they're definitely under referred and under tested. There's no doubt about that. I like to think it's getting maybe a little bit better. You know, I've been doing this for

Host: Hope so. Yeah.

Arlene Button, MS, CGC: Seems to be getting a little bit better. I've seen a few more men these days than I did when I started my career.

But yeah, I mean, I think that for a long time there was a misconception that a BRCA mutation was something you could only inherit from your mother. And so in a lot of cases people weren't even asking about the father's side of the family. And that's totally wrong.

You know, these mutations are dominant. They're autosomal dominant. So, we all get two copies of every gene in the body, including BRCA1, including BRCA2. If you have a mutation in one copy of either of those genes, you have higher risk of cancer. And when we have children, a child inherits one copy of each gene from mother and one copy from father.

So, if you have a BRCA mutation, there's a 50% chance you got it from your mom, 50% chance you got it from your dad. And the same way people were walking around on this planet who have BRCA mutations, half of them are men, half of them are women. The women we find a little bit more easily because they have the higher risk of cancer, they're more likely to present with breast cancer or ovarian cancer.

But the men have increased risk of cancer as well with BRCA. The risk of prostate cancer, could be up to 60% in some cases. And the risk of male breast cancer in BRCA2 is 8%. The risk of pancreatic cancer, you know, is about 6%. So these are all cancers that can impact men. But the women have the even greater risk where we're talking about the 70% risk of breast cancer, the 40, 60% risk of ovarian cancer.

So in a lot of cases we've kind of been trained to think about the women in these conditions, and then we miss the men. But the men have the cancer risk themselves, and there are screening guidelines for these men who have mutations. But then also if a person has a mutation, a man has a mutation, well, if he has children, those children are at 50% risk.

And it can be the whole branch of the family that's really being missed when we ignore a brother or a father or, or someone like that.

Host: It really emphasizes the point of the, the importance rather of understanding genetics, family history, you know, the hereditary nature of these things. Genetic counseling that's available at Carle Health. And just want to finish up today. We could speak for hours, I'm sure on this topic, but today, you know the headlines.

Maybe you can highlight the synergy between physicians and counselors in genetics.

Arlene Button, MS, CGC: Genetic counselors, we have Bachelor's degrees. And then we have master's degrees in genetic counseling. There aren't many of us. I think there are something like 5,000 in the country. And then a portion of us work in cancer. So a hospital like the size of Carle you know, we have two cancer genetic counselors, myself, and my coworker, Catherine Garrett.

We serve a critical role and especially in the cancer realm. And we are there to, you know, provide a service to those patients who are either at risk of cancer or they're experiencing cancer. And so the physicians who are, you know, treating the cancer, identifying the cancer, making the decisions about the plan to get that person, you know, through this journey, they look to the genetic counselor to give them that piece of information. Is this a hereditary condition that we're dealing with? If it is, you know, maybe they're going to make a different decision as far as like surgery, like in breast cancer, women who have BRCA mutations, they're going to have bilateral mastectomy instead of the lumpectomy, for instance.

Or if we're talking about pancreatic cancer or prostate cancer, maybe they could be, um, using a PARP inhibitor if this person has a BRCA mutation. So it's, it's that extra piece of the puzzle that the genetic counselor can give by doing the genetic testing and providing that correct interpretation so that, that the doctor does have all the information needed to, to make the right decisions about treatment for the particular cancer, but also, you know, in the future for that patient, maybe they survive their breast cancer. But if we're talking about BRCA or you know, there are other genes. We've only talked about BRCA, but there are the other genes.

 And if that person's at risk of another cancer, well then that needs to be a part of that patient's screening going forward. And then, also involving the family and getting a family what they need. So yeah, I think that synergy word is the right one. Because it's a small piece that we add, but for some patients it definitely changes the whole direction of their treatment.

Host: Right. Yeah. As you say, relatively speaking, there aren't a lot of you, right. But, uh, Carle has two, which is great and definitely can understand a little better today after speaking with you, the importance of physicians and counselors working together, both men and women being referred and tested, all that good stuff.

So thank you so much. I appreciate this.

Arlene Button, MS, CGC: You're welcome. Thanks for having me.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.