Though most cancers are not clearly linked to the genes, it is known that certain forms of cancer are more likely to have a hereditary association than others. Among these are breast, ovarian, colon, and uterine cancers. Thanks to advances in genetics, however, it’s now possible to test individuals for gene mutations that put them at increased risk of developing these or other cancers. To help assess patients’ cancer risk and promote more individualized screening and treatment protocols, Mercy Health offers genetic counseling and testing at the Mercy Health Cancer Centers.
Who qualifies for genetic testing to assess cancer risk, and how is this determined? According to licensed genetic counselor Michelle Hall of the Mercy Health Cancer Centers, “We look primarily at the types of cancer that occur in a family and the age at which they were diagnosed. Any time we see a cluster in each generation of a family, whether on the mother’s or father’s side, and it’s occurring under age 50, we know there could be a genetic link. For example, there may be several females in a family who developed breast cancer at a younger age. Another red flag is seeing cancers in a family that don’t occur commonly in the general population, such as ovarian cancer, pancreatic cancer, or male breast cancer. We find a hereditary association only about five to 10 percent of the time, but it’s always important to follow up on that red flag.”
For this reason, Hall stresses the importance of knowing your family’s health history. She encourages individuals to talk with their relatives to learn what conditions might run in their family, including cancer. This information can be valuable to determine whether genetic testing is indicated.
Prior to testing, an initial consultation is held for the purpose of educating the patient. Hall notes that it’s very helpful at this time for the patient to meet with a credentialed genetic counselor or other individual who specializes in genetics to learn what the process entails and to discuss the potential results, which are typically received within a few weeks of testing.
Discovering a genetic predisposition to a certain cancer (or cancers) does not mean the patient is predestined to get the disease, Hall emphasizes. “However, knowing which cancers he or she is predisposed to can really help guide our screening recommendations. Oftentimes, that means beginning screening at a younger age and screening more frequently. For instance, if someone is found to have a genetic predisposition to breast cancer, we may want them to begin breast cancer screening as early as age 25 because their lifetime risk is much higher than the average—between 50 and 85 percent higher. It’s so important for us to modify medical management for these individuals so we can detect any developing cancer at a very early stage through increased screening,” she adds.
In addition to guiding screening recommendations, the results of genetic testing can even help guide cancer treatment. The genetic profile of a given cancer is vital information doctors can use in predicting which cancers might—or might not—respond to a particular form of chemotherapy or immunotherapy. Patients, too, can use the results of genetic testing to help determine which preventive measures might be appropriate to lower their risk.
Hall cites the example of patients determined to be at high risk of developing breast cancer who choose to undergo bilateral mastectomy. “Prophylactic mastectomy isn’t necessarily a requirement in this situation, but it’s important to discuss all options and make that information available. When patients are considering this option, we will schedule them to meet with a breast specialist or breast surgeon to discuss the pros and cons, the types of surgery available, and the reconstructive options. It’s a very individualized decision, and we want to make sure it’s an informed one,” she says.
Though genetic testing for cancer offers a host of benefits, it’s not necessarily appropriate for everyone. As Hall explains, it’s very uncommon to find that a cancer is hereditary, so only a small subset of individuals actually needs testing. Also, those who qualify to be tested need to understand that there are limitations to the testing as well as potential emotional and psychological consequences to learning one is at increased risk for developing certain cancers. “Some people don’t want to hear that they’re genetically predisposed because this knowledge causes a lot of anxiety or they don’t want that burden placed on their family members,” she observes. “Still, if you have a family history of any type of cancer—not just breast cancer—and wonder whether testing would be appropriate, you should be an advocate for your health and have that conversation with your doctor.”
What to expect at a genetic counseling appointment:
- Review your personal and family history of cancer
- Determine your risk for a hereditary gene mutation
- Learn about the genetic testing process and possible test results
- Answer questions regarding insurance and cost of genetic testing
- Work with you and your doctor to establish personalized cancer screening and prevention recommendations. ❦