Monday, May 21, 2018 | 2 a.m.
Approximately five to ten percent of all cancers have a hereditary component. What does that mean and how can that information be leveraged to make better decisions?
Genetic risk assessments and counseling are vital in early detection efforts as well as customizing treatment plans.
In recent years, a few public figures have made headlines for discovering a hereditary mutation and taking proactive action. Stories such as theirs show the benefits of such testing. Angelina Jolie had a double mastectomy in February 2013 after learning she carried the BRCA1 gene. If she were to take no action, a breast-cancer diagnosis was a near certainty (90 percent) in her future. Nearly two years after the double mastectomy, Jolie had her ovaries and Fallopian tubes removed to stay one step ahead of an ovarian cancer diagnosis.
At the core of Jolie’s decisions? Cancer genetic counseling.
The counseling doesn’t expose certainties — not everyone with a mutation in a cancer gene will develop cancer, but the mutation greatly increases the risk.
Some of the common genes that may contribute to a cancer diagnosis include TP53, BRCA1, BRCA2 and PTEN. According to the American Cancer Society, mutations in specific genes are attributed to more than 50 hereditary cancer syndromes. Many people with the aforementioned mutated genes develop cancer at younger ages than the rest of the population. Genetic testing for those who are at high risk is now recommended and a standard of care in oncology today.
It is important to know if you or your family members have a hereditary predisposition to cancer, as there are now options to reduce the risk of getting cancer. Management care plans can include specific cancer screening exams, medications and/or preventative surgery. Treatment options are tailored to an individual’s risks and lifestyle. If possible, the best person in the family to test is the person who already has cancer.
The Risk Assessment and Test
Initial cancer genetic counseling sessions typically take less than an hour. A clinician will gather your personal medical history, family history, provide education and collect your DNA via a simple saliva or blood DNA test.
After one’s medical history, family history is the foundation for a risk assessment and the basis for identifying those people who are at an increased risk for developing certain cancers.
Both your mother’s and father’s history will be obtained as well as histories for your aunts, uncles, grandparents, siblings and your children. A cancer genetic counselor wants to know who has had cancer, what type of cancer they were diagnosed with and how old they were when they were diagnosed. These histories will determine whether further discussion or genetic testing for a hereditary cancer syndrome is needed. If it is determined that testingw is recommended, educational materials on cancer genetics and hereditary syndromes will be provided.
Meeting with a cancer genetic counselor is another necessary step. During the session, you will be provided with information on the specific test being performed, what the results mean, psychological implications of test results, confidentiality issues and the options for risk estimation without genetic testing. Additionally, you will learn about the risk of passing a gene mutation to a child, fees involved in testing, options and limitations of medical surveillance and strategies for prevention after testing and the importance of sharing your genetic test results with at-risk relatives.
The actual cancer genetic testing requires a saliva (buccal) sample. It is a simple procedure and takes a matter of minutes. The saliva is collected in a tube and obtains the DNA from the lining of your mouth, which is then processed in a laboratory for analysis. There is also the option of a blood draw if indicated.
Results are typically available two to three weeks after testing. These confidential results are disclosed in a way soz that you can understand the implications of a positive, negative or inconclusive result. Patients can expect guidance on how to share the results with family members and how test results may affect them. There are many medical management options available to those who test positive and you will be referred to the appropriate medical provider for follow up.
Comprehensive Cancer Centers is dedicated to providing the best care to its patients. Launching the cancer genetic screening program helps ensure that we are able to provide to our patients the most current and recommended services in oncology care. This program is the first to Southern Nevada in an oncology practice. We welcome all patients in our community and look forward to helping survivors and to identify “previvors,” those who have mutations but are not affected by cancer.
Barbara Caldwell, MSN, APRN is a cancer genetic counselor at Comprehensive Cancer Centers. With more than 40 years of experience in medicine, Caldwell sees patients at four Comprehensive treatment centers throughout Southern Nevada. For more information visit www.cccnevada.com /cancer-genetic-counse