E-Metab Panel (Estrogen Metabolism Breast Cancer Risk Estimate)

E-Metab Breast Cancer Risk Estimate
Price: $

Patients are asking about breast cancer risk

Breast cancer is the most common cancer in women and a leading cause of cancer death.1 So it's no surprise that patients want to know their risk. But breast cancer is multifactorial, so risk can be hard to calculate. Now, a simple genetic test plus clinical risk factors helps you fill the knowledge gap and give patients better answers.

E-Metab's combined risk assessment tool helps you give patients a better understanding of their risk.  The calculated risk in the report combines genetic (DNA) information with estrogen exposure data in evaluating total risk.2

BRCA testing for cancer-associated mutations only works for patients who meet certain criteria, such as strong family history or specific genetic heritage. For many patients, BRCA is also prohibitively expensive.

A new tool helps you assess each patient's risk
The E-Metab Panel from Iverson Genetics is a first-of-its-kind test for assessing individual breast cancer risk. It combines genetic information with clinical risk factors to give you a clearer picture of your patients' risk. Since E-Metab looks at factors affecting normal metabolism, any patient can use it
E-Metab is different from other genetic breast cancer tests. It looks at three genes that affect estrogen metabolism. Estrogen exposure is the major risk factor for breast cancer, before and after menopause.3,4 While BRCA testing looks for specific mutations that most women lack, E-Metab reveals

individual variations in genes that affect estrogen metabolism pathways. Genetic risk is calculated based on these variants. The genetic findings are combined with each patient's clinical risk factors to create a personalized risk estimate.

A unique tool that works for every woman

Traditional tools for assessing breast cancer risk calculate lifetime estrogen exposure based on clinical factors alone, such as age at menarche and menopause and number of children.5,6 These tools do not account for genetic variations in estrogen metabolism. Most people have 2 or more variations. Because all patients metabolize estrogen, every woman can use E-Metab for personalized risk assessment.

Results you can act on

E-Metab gives you a simple report indicating low, moderate or high risk for each patient. This combined risk estimate gives you the information you need to personalize care and screening decisions. Breast cancer risk assessment helps you and your patient make better choices about hormone replacement therapy (HRT), frequency of clinical breast examination and screening mammography, oral contraception and wellness, including smoking and alcohol use. Women at low risk can still benefit from making healthy lifestyle choices, while women at moderate or high risk can take steps to limit additional risk.

Who should consider E-Metab?

• Women considering HRT
• Women with a family history of breast cancer -- especially those who are BRCA-negative or do not qualify for BRCA testing.
• Patients who want to take charge of their health
• Any woman who wants to know more about her breast cancer risk
E-Metab is available for premenopausal and postmenopausal women. Every woman can benefit from the knowledge this unique test provides.

Factors associated with breast cancer risk:

Based on an individual patient's E-Metab test results, you may want to discuss the factors below and how they may play a role in breast cancer risk. In some cases, making lifestyle changes or personalized HRT choices may decrease risk.

• Estrogen exposure (endogenous)
• Age
• Family history
• HRT/hormonal contraception
• Smoking
• Alcohol use
• Radiation exposure

E-Metab is cost-effective

Testing for BRCA mutations can cost $1000-2000. High insurance deductibles may result in out-of-pocket costs of several hundred dollars or more. Most patients are not eligible for BRCA, cannot afford the cost of testing, or both. E-Metab provides cost-effective risk assessment. Even if not covered by insurance, the cost is within reach of many patients. (Because the E-Metab Estrogen Metabolism Panel is the first genetic test of its kind, insurance codes are in development.)

Part of the complete Women's Health Panel

For your convenience, a single requisition form includes the E-Metab Estrogen Metabolism Panel, DMEX Genotype Panel and MTHFR Panel, the Women's Health Initiative Panel from Iverson Genetics. This specialized group of tests helps you avoid adverse reactions to medication, assess risk and provide personalized care for each patient. You can also order E-Metab alone for patients who want only breast cancer risk assessment. Added cost may apply for additional tests. Contact support@iversongenetics.com for more information.

What do I do with my patients' E-Metab results?

High breast cancer risk--HRT
alternatives, lifestyle change

Mary, 43, is considering HRT for relief of menopausal symptoms. Her physician recommends assessing her breast cancer risk before starting HRT, and the results of Mary's E-Metab Estrogen Metabolism Panel reveal that she is at high risk for breast cancer. Her physician discusses HRT alternatives to relieve Mary's specific symptoms, such as low-dose fluoxetine to improve mood and topical therapy for vaginal symptoms. They also make a new plan for screening mammography and clinical breast examination.

Low risk--HRT with greater confidence

Daniela, 48, has vasomotor menopausal symptoms that are relieved by HRT, but after three years of therapy, she is concerned about increased breast cancer risk. The E-Metab Estrogen Metabolism Panel reveals that her breast cancer risk is low. After discussing the results with her physician, she has improved peace of mind and decides to continue using HRT while her symptoms remain bothersome.

Moderate risk--HRT with close
monitoring and shorter duration

Holly, 54, would like to start HRT but is concerned because her older sister had breast cancer. No other first-degree relatives have had it, so she does not qualify for BRCA testing. Her physician recommends the E-Metab Estrogen Metabolism Panel, and results show Holly has moderate risk. She starts HRT and opts for annual mammography and clinic visits.

1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62:10
2. Crooke et al. Estrogen Metabolism and Exposure in a Genotypic-Phenotypic Model for Breast Cancer
3. Farhat GN, Cummings SR, Chlebowski RT, et al. Sex hormone levels and risks of estrogen receptor-negative and estrogen receptor-positive breast cancers. J Natl Cancer Inst 2011;103:562;
4. Fortner RT, Eliassen AH, spiegelman D, et al. Premenopausal endogenous steroid hormones and breast cancer risk: results from the Nurses’ Health study II. Breast Cancer Res 2013;15:R19.
5. Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Shairer C, Mulvihill JJ: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81(24):1879-86, 1989.;
6. Armstrong K, Eisen A, Weber B. Assessing the risk of breast cancer. N Engl J Med 2000;342;564-571.
The Iverson Emetab Estrogen Panel tests specifically for the following genetic variants:

• CYP1A1 (*2C & *4)

• CYP1B1 (*3 & *4)