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26yo woman has several first degree relatives who have died of breast cancer in their 40s. She has heard of the BRCA1 gene and is considering the possibility of a genetic link in her family. She chooses to have BRCA1 testing and her results are positive. This is an autosomal dominant trait but unlike other genetic diseases, like Huntington’s, for example, it is not 100% penetrant. Rather, this is associated with a 45-85% lifetime risk of breast cancer compared to the 12% risk for any woman. There may be as many as 700 variants of BRCA1. At this time, it is unknown where each of those variants fall in the risk range.
1. Does this woman have a moral obligation to notify her future spouse of her test results? Why or why not?
2. If you were seeing this woman as an APRN, how would you counsel her on what she should or should not share with her future spouse? Why?
3. If this woman instead had a genetic disorder that was 100% penetrant, would it change your position on 1 and/or 2? Why?

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