To Your Health: Genetic counseling, testing can help in cancer fight
BY TERRI BLASE, DEBORAH OLESKOWICZ AND CHRISTINA RUIZ October 22, 2013 1:14PM
Updated: November 24, 2013 6:06AM
Did you know that your genetic makeup is a critical factor in determining whether or not you are susceptible to developing certain types of hereditary cancer?
For people who have a personal or family history of cancer, understanding and managing their risk for cancer is extremely important.
Is cancer hereditary?
Most cancer is sporadic, involving the interaction of lifestyle, environmental and genetic factors. About 5 percent to 10 percent of cancer is inherited. Individuals with a genetic predisposition have a higher chance of developing cancer in their lifetime and at an earlier age.
Over the last 15 to 20 years, great progress has been made in identifying the genes which predispose individuals to cancers such as breast, colon, ovarian and uterine.
How is breast cancer inherited?
All cancer involves changes in genes (called mutations) in the cells of the affected tissue (for example breast tissue).
In most cases these changes occur only in the affected tissue of the individual and are not passed on to children. This is called sporadic cancer.
In hereditary breast cancer, an individual is born with a mutation in one gene that they inherited from one of their parents. This mutation makes a person predisposed to developing cancer.
Some people who inherit the mutation will not develop cancer. Studies have demonstrated that there are multiple genes associated with an increased likelihood for inherited breast cancer.
Mutations in the BRCA 1/2 genes account for about 50 percent of all hereditary breast cancer. The lifetime risk for developing breast cancer is as high as 87 percent in women with a BRCA 1/2 gene mutation. The lifetime risk estimates for ovarian cancer among women with a BRCA mutation can be as high as 45 percent. Many patients, however, with a strong family history of breast cancer and other cancers are found not to carry a mutation in the BRCA1/2 genes.
Clues within the family history allow for further testing of other genes associated with inherited breast cancer. Laboratories recently have been able to offer genetic testing for multiple genes associated with inherited breast cancer at the same time on a panel.
Who should consider having genetic counseling/genetic testing?
Anyone whose personal and/or family history includes any of the following:
♦ Cancer before the age of 50.
♦ One family member having two or more different cancers.
♦ Two or more immediate family members with the same type of cancer.
♦ Several generations having the same or related type of cancer.
♦ A family member of Eastern European Jewish ancestry who has breast, ovarian or colorectal cancer.
♦ A family member with a rare cancer, such as male breast cancer.
♦ Concern about developing cancer because of family history.
What is genetic cancer risk counseling?
A genetic cancer risk assessment consultation involves reviewing an individual’s personal and family history to assess their risk for cancer.
A genetic counselor will spend time reviewing the role of genetics in cancer, discussing appropriate screening tests and medical evaluations, and explaining available genetic testing, when appropriate, including the risks, benefits and limitations. A follow-up consultation often is scheduled to review the genetic test results and the appropriate next steps for surveillance and medical management.
What are the benefits of genetic counseling and genetic testing?
Knowing an individual has an increased risk of cancer based on their personal/family history or genetic test results is important. An individualized cancer screening schedule that utilizes the appropriate screening and diagnostic tests and is based on the latest genetic information can result in an improvement in the health and quality of life for those who have a higher risk of cancer.
Genetic testing may identify one of the causes of cancer in the family. It can identify other family members, such as children and siblings, who are at increased risk of cancer and may benefit from cancer screening.
Genetic testing can identify individuals and their family members who are not at increased risk of cancer. Finally, finding a genetic mutation can aid in decision-making about risk-reducing preventative surgery.
What about genetic discrimination?
A federal act called the Genetic Information Nondiscrimination Act was signed into law in 2008. This law prohibits discrimination by health insurance companies and employers based on “genetic information,” which is defined as your genetic test results, your relative’s genetic test results and any information about your family history.
Group and individual health insurers may not use your genetic information to change your premiums, decline coverage or set eligibility. Employers may not use your genetic information to hire or fire an individual or make decisions about promotions.
For more information, call the Genetic Cancer Risk Assessment Program at Advocate Christ Medical Center at (708) 684-3373.
Terri Blase, Deborah Oleskowicz and Christina Ruiz are licensed genetic counselors at the Advocate Center for Breast Care, 4545 W. 103rd St., Oak Lawn.