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Ironwood Breast Surgeon Dr. Patricia Clark Co-Authors Journal of Clinical Oncology Article Underdiagnosis of Hereditary Breast Cancer

On December 7, 2018, an article I co-authored was published in the Journal of Clinical Oncology regarding need to re-examine the national guidelines for who should be tested for genetic predisposition to develop breast or ovarian cancer.  We used an 80 gene panel to test over 1,000 patients with breast cancer, half who met NCCN Guidelines recommending genetic testing and half who didn’t. We found no difference in the rate of mutations between the group who met the guidelines and those who didn’t.  As a result of this study results, I decided to abandon the national guidelines.

A decade ago, genetic testing for just the BRCA gene could cost over $3,000. Next-generation sequencing and other advancements made panel testing more accessible to the public.  Insurers will cover the cost when guideline criteria are met. Even when a patient’s insurance doesn’t cover the testing, the gene panels are $250 or less.  Genetic testing for predisposition to breast and ovarian cancer are within reach for most patients and are even available over the Internet.

I now offer genetic testing to all of my breast cancer patients and any patient that requests it regardless of the guidelines.  I believe it is important physicians or genetic counselors stay involved in the genetic testing process to ensure patients receive appropriate counseling and follow-up of results with management recommendations. Testing provides peace of mind and gives us the opportunity to either prevent the cancer or to detect at an early stage through appropriate surveillance when the opportunity for cure is highest. It also identifies family members who do not carry the pathological mutations and whose risks are no higher than the general public despite their family history.

Thank you,

Breast and Oncoplastic Surgery

Ironwood Women’s Centers


Full Article in Text

Full Article in PDF

To learn more about Dr. Clark click here.

What do Genetic Testing Kits Reveal about Cancer Risk?

Advertisements for genetic testing kits are everywhere you look lately.  The appeal is easy to understand.  Who doesn’t want to know more about where they came from?  It’s a marvelous testament to technology that a sample of saliva can reveal our genetic history.  It’s interesting to discover genetic lineage but what can these tests tell us about health risk?


We sat down with Certified Genetic Counselor Mandy Kass from Ironwood Cancer and Research Centers to get some perspective.   It turns out that, like your DNA, it’s complicated!  Your genetic information is not a crystal ball but can reveal factors that can make you more prone to certain health conditions.  Direct to consumer genetic testing don’t tell you anything about cancer risk at this point in time.   Speak with your provider or genetic counselor in Arizona for help interpreting your genetic report.

To learn more watch Mandy’s video!

An Introduction to Genetic Counseling

My name is Mandy Kass and I’m the genetic counselor for Ironwood CRC. I graduated from ASU in May 2013 with my Bachelor of Science in Psychology and then went on to pursue my Master’s degree in Human Genetics from Sarah Lawrence College in New York City. This specialized training allowed me to be exposed to all areas of genetics including oncology, which is my passion.


As a genetic counselor, one of the biggest questions I get asked is, “what is genetic counseling?” Cancer genetic counseling involves using a patient’s personal and family history of cancer to better determine whether or not they are at risk for having an inherited predisposition to cancer.

The way that we determine whether or not someone is at a high risk for these inherited predispositions, is by looking for certain red flags. These red flags include:

-Cancer diagnosed at a young age (Under the age of 50)

-A strong family history of cancer involving certain cancer types that appears to track through the generations

-Rare cancer types like ovarian cancer for example, or cancers occurring bilaterally (in both of a pair of organs)

-Multiple primary cancer types in one person

-Ashkenazi Jewish ancestry


Once we’ve determined that someone is at a high risk, we can pursue genetic testing.  Our goal is identify a genetic change that puts them at an increased risk for certain cancer types.


Why do I need Genetic Testing?

With genetic testing, we can attempt to identify a genetic change that causes a predisposition to cancer.  This allows us to create a screening plan that manages these specific cancer risks. When we identify an inherited predisposition in a patient, we can then offer testing to family members to identify those who are also at an increased risk, and should be having increased screening.


Genetic Counseling for Cancer in Arizona is a service that is available to all Ironwood Cancer and Research Center patients, so if you think you would be a good candidate for genetic counseling, talk to your Ironwood physician at 480-821-0238 or visit our website.