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Breast and Ovarian Surveillance Service (BOSS)
About Our Services
Do you have questions or concerns about your risk or a loved one's risk for breast or ovarian cancer? Are you a breast cancer survivor concerned about hormone replacement therapy or the risk of developing other cancers? Do you want to find out about genetic testing for breast and ovarian cancer?
The Johns Hopkins Breast and Ovarian Surveillance Service (BOSS) can help you find the answers to your questions and help you understand what your risks are. Our caring and expert team of physicians, genetic counselors and nurse practitioners can put this information into perspective for you and help you use it to your best benefit. Our expert team will:
- review your family history and other risk factors
- provide individualized risk assessment
- perform a clinical breast exam and instruct you in breast self-exam
- discuss and offer genetic testing to evaluate inherited cancer susceptibility
- provide individualized cancer prevention and screening information
 Johns Hopkins Ovarian Cancer Website
How To Make An Appointment
410-502-7082 - To make an appointment with the Breast and Ovarian Surveillance Service (BOSS), you can contact Linda Thompson, BOSS Referral Coordinator. She will obtain the appropriate information about you and schedule an appointment for you.
A pre-visit questionnaire and family history form will be sent to you to be completed prior to your visit. Information on the clinic location, directions and parking will also be sent to you.
The BOSS Team
Constance A. Griffin, M.D.
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Title (s):
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Associate
professor of Oncology, Pathology and Medicine.
Director, Cancer Risk Assessment Program
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Degree(s):
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M.D.,
University of Cincinnati College of Medicine, Cincinnati, Ohio
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Postgraduate Training:
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Cytogenetics,
Departments of Pathology and Genetics, University of Pennsylvania School of
Medicine, Philadelphia.
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Board Certification:
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Diplomat
of the National Board of Medical Examiners
Diplomat of the American Board of Internal Medicine
Diplomat of the American Board of Internal Medicine in Medical Oncology
Diplomat of the American Board of Medical Genetics
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Clinical Interests:
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Cancer
Genetics and Predisposition Testing
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Deborah K. Armstrong, M.D.
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Title (s):
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Assistant
Professor of Oncology, Gynecology and Obstetrics
Director,
Breast and Ovarian Surveillance Service
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Degree(s):
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M.D.,
George Washington School of Medicine, Washington, D.C.
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Postgraduate Training:
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Intern,
Internal Medicine, University of Pittsburgh
Resident, Internal Medicine, University of Pittsburgh
Chief Resident/ Instructor, Internal Medicine, Univ. of Pittsburgh
Clinical Fellow in Oncology, the Johns Hopkins University School of Medicine
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Board Certification:
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National
Board of Medical Examiners
American Board of Internal Medicine
American Board of Internal Medicine, Medical Oncology
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Clinical Interests:
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Breast
Cancer, Ovarian Cancer, Gynecologic Oncology, Medical Oncology, Cancer Risk
Assessment
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Kala Visvanathan, M.D.,
M.H.S.
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Title (s):
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Assistant Professor of Epidemiology, Active Staff in
Oncology
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Degree(s):
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MBBS, University of Sydney, Sydney Australia, FRACP Royal
Australasian College of Physicians. MHS (Clinical/Cancer Epidemiology) Johns
Hopkins Bloomberg School of Public Health
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Postgraduate Training:
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Intern, Internal Medicine; Royal Prince Alfred
Hospital/University of Sydney
Resident, Internal Medicine; Royal Prince Alfred
Hospital/University of Sydney
Senior Internal Medicine Fellow, Royal Prince Alfred
Hospital/University of Sydney
Clinical fellow in Oncology; Royal Prince Alfred, St
George Hospital and Concord Hospital/University of Sydney
Clinical Fellow in Oncology; The Johns Hopkins University School
of Medicine
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Board Certification:
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Internal
Medicine and Medical Oncology in Australia
Board
Eligible in the United States of America
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Clinical Interests:
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Breast Cancer,
Cancer risk assessment, Cancer prevention, Management of women at an
increased risk of cancer.
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Jennifer E. Axilbund, M.S.,
C.G.C.
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Title(s):
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Certified
Genetic Counselor, Cancer Risk Assessment Program
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Degree(s):
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Master of
Science, Genetic Counseling, University of Colorado, Denver, CO
Master of
Science, Molecular Biology and Genetics, Northwestern University, Chicago, IL
Bachelor
of Science, Biology, Virginia Polytechnic Institute and State University,
Blacksburg, VA
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Board Certification:
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American
Board of Genetic Counseling
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Clinical Interests:
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Genetic
counseling; Genetic testing for cancer susceptibility; Familial Pancreas
Cancer; Mid-Atlantic Cancer Genetics Network
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Susan Appling, R.N., M.S.,
C.R.N.P.
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Title(s):
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Adult
Nurse Practitioner, The Johns Hopkins Breast Center
Assistant Professor, The Johns Hopkins School of Nursing
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Degree(s):
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Master of
Science in Nursing, Adult Primary Care, Adult Nurse Practitioner Program,
University of Maryland at Baltimore
Bachelor of Science in Nursing, University of Maryland at Baltimore
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Board Certification:
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American
Nurses Credentialing Center
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Clinical Interests:
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Breast
cancer screening and prevention; Cultural diversity; Genetic predisposition;
Menopause and hormonal replacement issues, use of soy, faculty evaluation
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Connie Ziegfeld, M.S., R.N.
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Title(s):
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Clinical Specialist and Case
Manager for Community Programs at the Sidney Kimmel Comprehensive Cancer
Center, Clinical
Specialist, The Johns Hopkins Breast Center
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Degree(s):
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Master of
Science in Nursing, University of Maryland
Bachelor of Science in Nursing, Towson University
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Board Certification:
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Clinical Interests:
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Breast and Prostate Cancer Screening and prevention, High
risk screening for breast cancer, professional and patient education.
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What You Should Know About Genetic Testing
Approximately 5-10% of breast cancer cases are thought to be due to an inherited genetic abnormality. Families most likely to have an inherited form of breast cancer are those in which there are multiple cases of breast cancer occurring before menopause, cancer involving both breasts, a male with breast cancer, or a family history of breast and ovarian cancer. Two breast cancer susceptibility genes, named BRCA1 and BRCA2, have been identified, and testing is available to look for abnormalities in these genes. However, these two genes are expected to account for only half of all families with hereditary breast cancer. Scientists are likely to find many more genes associated with increased risk for breast cancer. Therefore, current testing may not be advanced enough to find the exact genetic alteration in a particular family.
If someone with a significant family history of breast and/or ovarian cancer is interested in genetic testing, it is recommended that a relative who has had breast or ovarian cancer be tested first. If a family member with cancer is tested and found to have an abnormality in one of these genes, other relatives with or without cancer may be tested for the specific alteration identified. If a family member without cancer tests negative for the gene change that is known to be present in the family, the chance for developing breast or ovarian cancer is probably no higher than the risk faced by an individual without a significant family history. If the family member without cancer tests positive, the risk for developing breast or ovarian cancer is substantially increased, but not 100%.
Genetic testing can often provide valuable information about an individual's risk for cancer. This information may be used to develop a management plan that includes more screening in an effort to detect cancer early and effectively treat it. Genetic testing may also reveal who in a family does not need such intense screening. Unfortunately, there are currently no known methods to prevent cancer in those who test positive. However, there are ways to reduce ones risk of breast cancer, such as Tamoxifen or prophylactic surgery. Regardless of the result, genetic testing has the potential to provide some information about cancer risk.
There are also certain risks associated with genetic testing for cancer susceptibility, including the possibility of insurance or employment discrimination. There are some federal and state laws designed to lower the risk of insurance discrimination, but they only pertain to specific types of insurance. Other risks of genetic testing are adverse psychological reactions and disrupted family relationships. An individual who tests positive may experience anxiety, guilt, depression or fear. Family members may have similar feelings, which could cause strain between relatives.
Because the majority of breast cancers are not due to inherited susceptibility, only certain individuals are appropriate for genetic testing. Individuals who might consider genetic testing include a woman with breast cancer before menopause who has a family member diagnosed with pre-menopausal breast cancer or ovarian cancer at any age; a woman diagnosed with both breast and ovarian cancer; a woman with pre-menopausal breast cancer or ovarian cancer who is of Ashkenazi Jewish descent; a man with a personal history of breast cancer; or a relative of an individual with an identified BRCA1 or BRCA2 mutation.
Genetic testing tends to be quite expensive, and usually costs $2800 for the first family member tested. If a mutation is identified, testing of other family members for the identified mutation is approximately $350. For Ashkenazi Jewish individuals, testing is more straightforward, and costs about $400. Many insurance companies cover the cost of genetic testing, though most companies require that the family history meet specific requirements.
Individuals considering genetic testing are encouraged to meet with a genetic counselor to discuss the benefits, risks and limitations of genetic testing in detail. The genetic counselor will also determine the likelihood of detecting a genetic alteration in a specific individual or family, and discuss management recommendations. Genetic counseling is available through the Breast and Ovarian Surveillance Service.
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