ERMLINE BRCA1 OR BRCA2 gene mutations significantly increase a woman's risk of breast cancer (50%-85%) and ovarian cancer (16%-50%). 1-5 Identifying women who have had BRCAassociated breast cancer is important because the risk of a new primary breast cancer within 10 years following initial diagnosis is as high as 40% in the absence of oophorectomy or tamoxifen treatment. 6 The corresponding 10-year risk of ovarian cancer is also substantial (6%-12%). 7 Limited-stage breast cancer patients who carry a BRCA gene mutation are offered the option of riskreducing mastectomy, and oophorectomy is recommended. 8,9 Documented efficacy of screening and risk reduction interventions provides evidence for individualized risk management advice, making genetic cancer risk assessment (GCRA) a component of medically necessary care. 10,11 Identifying appropriate candidates for GCRA is challenging. The general consensus (eg, American College of Medical Genetics, National Comprehensive Cancer Network 11-14) is that BRCA testing is not appropriate for unaffected women in the general population, but there is less clarity in this re-For editorial comment see p 2637.

Clinicians attending continuing education sessions in California were surveyed about their beliefs and attitudes regarding genetic discrimination and their knowledge of protective legislation. Two hundred seventy-one surveys were collected from physicians (n = 191) and nurses (n = 80). Most respondents lacked information or were misinformed about the existence of protective legislation (58.3%) or published cases of insurance discrimination (85.2%); 52.4% believed that mutation carriers have difficulty obtaining health insurance; 13% would not encourage genetic testing, despite a family history of cancer. Clinician concerns about potential genetic discrimination, and lack of information regarding protective legislation, may influence access to care.

No abstract

The influx of Asian or Pacific Islander immigrants has created a challenge for United States public schools. The purpose of this article is twofold. First, it elucidates the unique situation the Asian or Pacific Islander child faces in public schools by using a case study and a vulnerability model. Its second purpose is to provide school nurses with important tools to guide them in caring for these vulnerable children. The tools consist of an assessment questionnaire for school nurses to use when they measure a child's vulnerability level and tips to improve communication with non-English-speaking children. School nurses can use the information obtained from these tools to initiate primary, secondary, or tertiary prevention.