Cedars-Sinai Launches New Cayton BRCA Center

The new Cedars-Sinai Cayton BRCA Center is helping women and men with BRCA genetic mutations manage their risk of developing cancer. The center, which will open in early July, thanks to a $30 million gift from the Cayton Goldrich Family Foundation, provides coordinated screening, genetic counseling, fertility planning, treatment and preventive care in one location.

"The generosity and foresight of the Cayton Goldrich Family Foundation gave us the resources to conduct outreach and coordinate care for these patients," said Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. "By bringing together our dedicated physicians and recruiting top talent from around the country, we are making this centralized BRCA center unlike any other."

Individuals of Ashkenazi Jewish descent, and those with family history of breast, ovarian, prostate or pancreatic cancer, or people who have been diagnosed with one of these cancers, should be screened for BRCA1 and BRCA2 mutations, Ferrone said.

Cancer Screenings

"This center will provide every relevant service: comprehensive risk assessment, state-of-the-art surveillance, prevention strategies, clinical trials, and access to the latest scientific discoveries," said Farin Amersi, MD, a surgical oncologist who treats patients with BRCA mutations. "More importantly, it will create a true home for patients and families facing hereditary cancer risk."

A patient's first visit to the center begins with genetic counseling to help patients understand their unique cancer risk. For women, the initial visit also includes a breast MRI or mammogram, and a pelvic ultrasound and blood test to screen for ovarian cancer. Men undergo imaging to screen for breast cancer and an exam and blood test to screen for prostate cancer. For pancreatic cancer, both men and women may have abdominal imaging and discuss the possibility of endoscopy screening, depending on their individual risk.

"At many other institutions, patients diagnosed with a BRCA mutation have to make appointments for each of these screenings separately, with different physicians," Amersi said. "Our patients will have all their screenings-and receive their test results-in one visit. This will help relieve the anxiety of juggling multiple appointments and waiting to learn the results of these tests."

The process condenses what could be eight to 12 different appointments into a single day, Ferrone said.

"For patients with BRCA mutations, these screenings are repeated every six to 12 months, so you can imagine how disruptive separate appointments are for patients, many of whom work and have families," Ferrone said.

Based on their test results, patients meet with a team of specialists about the best path forward, taking into account the patient's age, fertility goals and individual cancer risk.

Preventive Treatment

For breast and ovarian cancer prevention, patients and their care team discuss the need and timing for possible preemptive surgery.

BRCA1 and BRCA2 mutations have slightly different risks associated with them, said Marla Scott, MD, a gynecologic oncologist.

"People with BRCA1 mutations have roughly a 40% higher risk for gynecologic cancers, and are a younger average age when cancer tends to appear," Scott said. "This means we have a discussion about removing the fallopian tubes and ovaries, as well as consideration for hysterectomy and mastectomy, between ages 35 and 40."

A reproductive endocrinologist is on-site to discuss fertility preservation-including egg and embryo freezing and in-vitro testing and fertilization-as well as hormone replacement options to manage symptoms of surgically-induced menopause, Scott said.

For people with BRCA2 mutations, there is a slightly lower increased risk of gynecologic cancer, and age of cancer onset tends to be about 10 years later, allowing doctors to delay preventive surgeries, Scott said.

"With the exception of regular breast exams, patients may get to 'graduate' out of further screening for gynecologic cancers if they have a risk-reducing surgery and show no signs of cancer," Scott said.

Scott added that while managing cancer risk can be challenging for people with a BRCA mutation, having a place they can go for guidance is empowering. The hope, Ferrone said, is that community outreach efforts will bring these benefits to even more patients.

"We are incredibly fortunate to be able to offer free genetic testing in high-risk populations in the near future," Ferrone said. "This will help us identify more at-risk patients and get them enrolled in the appropriate programs to help them manage their risk and preserve their health."

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