KeepHealthCare.ORG – Genetic testing can reveal genes that might predict cancer
EVERETT — Walking into Joy Varady’s office can be life-changing for her patients.
She could either tell them they have breast cancer, or that they might someday.
“It’s a very hard job to do, giving a breast cancer diagnosis. It’s very heavy,” Varady said. “The genetic testing, which to me is kind of more of preventive medicine, kind of balances that out because it’s all about trying to prevent these cancers.”
Varady has worked at Providence Regional Medical Center Everett for 26 years. She’s been a nurse practitioner in the Comprehensive Breast Center for 15. There, she gives breast cancer diagnoses and tests for certain genetic mutations that cause breast, ovarian, colon and other cancers.
Some cancers can be prevented after a genetic mutation is found. Frequent screenings to catch diseases early, using birth control to avoid ovarian cancer and taking other medicines can help. People could also choose to have tissue removed, such as breasts and ovaries.
People should get testing if their relatives have had cancers, or if they don’t know their family history, Varady said. Even if results come back negative, a person might still be at risk for conditions not included in the test.
Varady uses two tests from different labs, and which one she picks depends on the patient. Myriad costs about $4,000. The other, Color, provides less information and costs $249. Both companies accept insurance. So far this year, more than 800 people have sought testing at the breast center.
“I highly recommend people try to see a provider like me to talk about the pros and cons of testing, because we want to have your informed consent,” she said. “One of the huge things we want to educate patients about is insurance issues.”
Before the breast center opened in 2002, Varady was an OBGYN nurse practitioner. She was on a committee to open the new program in the Pavilion for Women and Children, and knew they were hiring. She had just given birth to her daughter and things were getting hectic at work.
“I had a really, really busy practice and I just had a little baby, and it was hard because back then you used to go home with your chart. You can’t do that anymore,” she said. “I would go home and chart after I put her to bed, and that was kind of crazy, so I said, ‘I can’t do this anymore.’ ”
She was hired to give breast cancer diagnoses and guide patients through treatment.
One day, she opened a door in her office and a piece of paper fell onto her desk. It was information about becoming certified to test for BRCA, or breast cancer, gene mutations. At the time, the University of Washington in Seattle was the closest place for testing. She called the company, and went for it.
Varady is the last genetic counselor before the Canadian border in Washington. King County has the highest density of the specialists.
Nearly a decade later, Varady became certified to test for more genes through City of Hope. She wanted all patients to have the same level of care. In 2015, Varady became an advanced genetic nurse through the American Nurses Credentialing Center. The program has since been dropped, but Varady is still certified.
“We call the patients we find with these genes pre-survivors,” Varady said.
Other times, it’s too late for testing.
When that’s the case, Varady calls breast cancer patients into her office to be diagnosed.
She lets them bring family for support. She helps build a treatment plan and makes appointments with oncologists, surgeons and other doctors. Patients leave with a notebook full of information.
After all the years, she’s realized it takes about an hour for people to absorb the news. Sometimes they still aren’t ready to go.
“I know I have devastated someone when I give that initial diagnosis,” Varady said. “By the time I am done with them, they process it through a little bit, and usually I can tell they’re going to be OK when I leave.”
Some situations hit closer to home than others, and the number of diagnoses she gives vary by the day.
She’s learned the importance of leaving it behind when she walks out of her office.
“What I love about this is that I know I have helped them,” Varady said. “They’re going through a really awful thing in their life, and we can help them through the process and make it a little bit easier. That’s what my goal is.”
Stephanie Davey: 425-339-3192; sdavey