Early Cancer Detection and Prevention
Genetics: Does cancer run in your family?
Cancer is a common disease in the general population. For some people, however, the risk of developing cancer is elevated. Like eye color and skin color, increased cancer risk is a trait that can be passed down in families. About 5 to 10 percent of all cancers result from gene changes that can be inherited.
The rest are due to a variety of factors interacting in a random fashion (including environmental factors, lifestyle factors and other genes.) The Clinical Cancer Genetics program at Medical City Dallas provides genetic counseling and testing for all types of cancer and hereditary cancer syndromes. This testing can help high-risk individuals and families before cancer occurs.
Our program is dedicated to the education of patients, providers and the community regarding genetic information specific to cancer risk, diagnosis and treatment. We strive to provide the highest quality of genetic counseling and hereditary cancer risk assessment to our patients.
How can I obtain more information about genetic testing?
If you have questions concerning genetic counseling, cancer risk assessment or insurance coverage of genetic testing, the cancer genetics office may be reached by calling (972) 566-4119.
What is genetic testing and what can it tell you?
Cancer genetic testing looks for the presence of an inherited gene mutation or alteration that increases the risk of developing cancer. It tells us why some families develop cancer more frequently than others, which individuals in a given family are likely to develop cancer in the future and what types of cancer we should screen for in order to decrease cancer risk.
Who should be referred for genetic testing?
- Individuals who meet the National Comprehensive Cancer Network® genetic testing guidelines/criteria or criteria for clinical diagnosis of a well-described hereditary cancer syndrome.
- Individuals with a personal/family history of early onset cancer (usually before age 50) Multiple cancers in the same individual
- Strong family history of cancer (multiple family members/multiple generations)
- Personal/family history of rare cancers, such as male breast cancer or ovarian cancer
- Individuals of Ashkenazi (Central or Eastern European) Jewish ancestry, especially those with a personal/family history of cancer
- Individuals concerned about cancer risk/interested in personal cancer risk assessment
What Testing is Available?
We facilitate testing for all types of cancer and hereditary cancer syndromes. This includes adult-onset syndromes such as Hereditary Breast/Ovarian Cancer syndrome and Lynch syndrome as well as more rare syndromes such as Familial Adenomatous Polyposis, Multiple Endocrine Neoplasia Type 1 or 2, Birt-Hogg-Dubé syndrome, Hereditary Diffuse Gastric cancer, and more. We also provide counseling and testing for conditions that can have childhood-onset, such as retinoblastoma and von Hippel-Lindau syndrome. Genetic testing can be performed for a single gene or in the context of a panel of genes, depending on personal and family history of the patient. Lab selection is dependent upon multiple factors, including what test is most appropriate for a patient, insurance specifics, if a mutation is known in the family, how much information patient/physician desire, out-of-pocket cost and turnaround time.
Genetic testing sessions involve approximately 1 to 1.5 hours of dedicated time tailored to each individual patient to discuss his or her personal and family history of cancer.
What Occurs in a Typical Session?
- Personal medical history is gathered and reviewed
- A three generation (or more) cancer family history is taken
- Contributors to cancer are discussed (both environment and genetic factors)
- Explanation of inheritance of gene mutations using their family history as an example
- Discussion of possible hereditary cancer syndromes that may be present in the family (including known cancer risks and management)
- Discuss possible testing options and most appropriate test options given personal and family history (single gene vs. panel testing, panel test options, laboratory options)
- Explanation of basic possible test results including positive, negative, and variant of unknown significance (VUS)
- Thorough discussion of insurance, cost of genetic testing, and what to expect from the laboratory
- Discussion of GINA (the Genetic Information Non-Discrimination Act) and its coverage and limitations
- Patients are plugged into national and local support groups and resources (such as the DFW hereditary patient conference for mutation positive individuals)
What Occurs in a Session for Patients with a Known Hereditary Mutation?
- We review inheritance of this gene mutation and which side of the family it likely originates from
- We discuss in detail the cancers and risks currently known for that specific gene mutation (different mutations in the same gene can carry different risks)
- We discuss any autosomal recessive disorders associated with that particular gene and mutations in that gene, such as with BRCA2 and ATM (if applicable)
- We discuss single site testing for family members, who in the family needs to consider testing, and how to disseminate this information (our clinic writes a “family letter” for patients to send to at-risk relatives to inform them of this information)
- We discuss in detail the current recommendations for management of these cancer risks specific to this gene mutation
- Patients are encouraged to check in with their physician and genetic counselor to learn if any new guidelines or updates in cancer risks/management have occurred for their hereditary cancer gene
How are results of genetic testing used?
If a mutation is identified, the counselor will review current recommendations for medical management. The results of genetic testing are most effectively used when shared with both physicians and family members. Sharing genetic information with physicians helps to ensure appropriate management. Positive test results confirm high-risk status and give family members the opportunity to be proactive in reducing cancer risk.
If a gene alteration is identified, what can I/my family do to decrease cancer risk?
There are currently a number of options for hereditary cancer families. These include more frequent or earlier screening to increase the likelihood of early detection, taking medications to reduce the likelihood of cancer development and, in some cases, removing at-risk tissue before cancer occurs. Genetic counselors work closely with physicians to make sure that hereditary cancer families are managed according to the most recent guidelines for high-risk families.
Will my insurance cover the cost of genetic testing?
Insurance companies often cover most or all of the costs of genetic testing. Eligibility for coverage depends on a combination of medical and family history. Having an early diagnosis of cancer before age 50 and/or a strong family history of cancer increases the likelihood of insurance coverage.
The Future of Cancer Genetics
Each year, new genes are discovered and testing improves. This leads to recognition of new hereditary cancer syndromes and a better understanding of existing syndromes. Before 2012-2013, most patients had testing of only 1 to 5 genes. Since that time, the standard practice is for many genes to be assessed at once using gene panels. These panels can evaluate as few as two genes to more than 100 genes. Since these significant advances have been made in a short period of time, patients who were previously tested (with positive or negative results) may want to return for further assessment.
Genetic counseling is a very important part of genetic testing, as there are benefits and limitations to any genetic test and important factors to consider. The recommendations for management of patients with an identified mutation are constantly evolving. Genetic counselors work continually to keep patients and physicians informed, as these changes can greatly impact patient care.