Cancer in Your Family?
Find Out Whether You Are At Risk
Angela Pickart, MS, CGC
Froedtert & Medical College of Wisconsin Genetic Counselor
Is cancer a big part of your family history? Have several family members experienced early cancer, multiple cancers or unusual cancers? Angela Pickart, MS, CGC, discusses a program that can help you assess your personal risk and take preventive action.
Q. Describe the Froedtert & Medical College of Wisconsin Cancer Genetics Screening Program.
The Cancer Genetics Screening Program is designed to assess the likelihood that a cancer seen in a family is hereditary. We determine whether any sort of genetic testing is appropriate for the family and also assess what screening and management options are appropriate.
Q. Who should take advantage of this program?
Anybody who is concerned about a family history of cancer. One hallmark of a hereditary form of cancer is, obviously, a lot of cancer in a family in multiple generations. We also pay attention to cancers that occur earlier than we would expect – for example, breast cancer or colon cancer under the age of 50. Another hallmark is any family history of individuals with multiple primary cancers – for example, a family member who had breast cancer and ovarian cancer. In addition, unusual or rare cancers, like male breast cancer, can sometimes be a signal of a hereditary predisposition.
Certainly, we’re happy to see anybody who has concerns. Some of the value in our program is looking at a family history and being able to tell an individual that this doesn’t look like it’s hereditary.
Q. How effective is genetic counseling in preventing cancer?
The merit of this type of counseling – and in some cases genetic testing – is that if we can identify a hereditary predisposition to cancer, we’ll be able to identify who within a family inherited that predisposition.
For individuals who have inherited a predisposition, screening and management guidelines differ greatly from what we would recommend in the general population. We often initiate cancer screenings much earlier than normal. For example, in women from families with hereditary breast and ovarian cancer, we start mammograms at age 25.
It may be that a person’s risk is increased for a cancer we don’t screen for at all in the general population. So, we’re going to screen for that cancer when normally we wouldn’t.
Often, people consider surgical options to reduce their risk. For example, with hereditary breast and ovarian cancer, a woman could choose to have her ovaries or her breasts removed to reduce risk.
We know that all these things – earlier screenings, preventive surgery, taking medication to reduce the risk, screening for a cancer you normally wouldn’t screen for – can make a huge difference.
Q. Could you walk us through the program?
First, we first get a little information over the phone – what the patient’s main concerns are, why he or she is coming in. Then we mail a packet of information to get the patient thinking about his or her family medical history.
The visit takes about an hour and a half. At that time, we draw out a detailed, three- to four-generation family tree. We give the patient information about basic genetics, counsel them and then – based on family and medical history – we let the individual know what we think the likelihood is that the cancers within his or her family are hereditary.
If there is a reasonable likelihood of a cancer being hereditary, we talk about various genetic testing options and review benefits, risks and limitations of those options. We can also talk about available medical management options.
If there is an appropriate genetic test available and a person wants to pursue it, we work with his or her insurance company to obtain prior authorization. We draw a blood sample on another visit. Once results are available, we do an in-person disclosure to talk about the test results, what they mean and what the implications are for the individual and the rest of his or her family.
Q. The results of genetic testing can be disturbing. How do you handle this?
Before an individual undergoes testing, we have a long discussion about its risks and limitations. Obviously, that’s one of the primary risks—finding out you’re at quite high risk for developing one or more types of cancer can be emotionally overwhelming.
People don’t often think about the impact on the rest of their family. We see situations where genetic testing puts stress on the family unit. Some family members may want to be tested. Other family members don’t. Genetic testing is a really important and difficult decision to make and it’s really an individual decision—it’s not a requirement. Some people have a family history of a known gene mutation and choose not to be tested. They don’t want to see that result in black and white, and they’d just as soon screen themselves as though they were high-risk.
We spend a lot of time working through those issues in the results session as well. We often end up working with the entire family. We can get them set up with various mental health professionals and refer them to an online support group called FORCE—Facing Our Risk of Cancer Empowered—a wonderful group specifically for women at hereditary risk of breast and ovarian cancer. There are other support groups for other hereditary cancers.
I think a lot of people find great comfort in speaking with other families and people who know what it’s like to be at very high risk and who are making difficult decisions about screening and management.
Q. What portion of all cancers are hereditary?
Overall, about 5% to 10%. As we gain more knowledge in this area, we are going to identify genes that moderately increase risk, so more and more people will have the opportunity to get a “risk profile” through genetic testing.
Q. Once you have established a hereditary risk, what is the patient’s next step?
The Froedtert & Medical College of Wisconsin Cancer Genetics Screening Program has access to several multidisciplinary teams – we work closely with breast surgeons, colorectal surgeons and various other specialists who can provide input and patient care, if necessary. That way, we don’t leave the individual hanging as to where to go next.
Q. Patients Can Depend on Genetics Team
Everyone who goes through the Froedtert & Medical College of Wisconsin Cancer Genetics Screening Program receives counseling from a board-certified genetic counselor. The clinical team also includes a surgical oncologist and a geneticist from the Medical College of Wisconsin. In addition, patients have access to medical imaging and psychological support services.
For more information on the Cancer Genetics Screening Program, call 414-805-3666 or 800-272-3666.