With the New Year approaching, being proactive about your health is likely a top priority. If that includes managing a cancer risk related to a strong family history, it might be time to ask your provider if you could benefit from genetic counseling.
Dorothy Parish, PA-C, and Nicole Poston, MSN, APRN, FNP, RNFA, provide the service in the genetics clinic at Regional One Health Cancer Care.
“In many ways, genetics is the future of medicine,” Parish said. “The goal of genetic testing is to identify cancer as early as possible…and in some cases, prevent it altogether.”
Parish sees patients who have been diagnosed with cancer and those who have not.
Patients with a cancer diagnosis are referred by their oncologist. “Their physician wants to learn more about why they have cancer,” Parish explained. “They suspect the patient has an inherited genetic mutation predisposing them to cancer.”
Those without a cancer diagnosis come through primary care referrals: “Enough family members have had cancer that testing is warranted under the established guidelines,” Parish said.
At a genetic counseling visit, Parish delves deep into family history. “We construct a pedigree together, a family tree for cancer. First, patients identify who in their family has had cancer and the age of diagnosis. Then, we look at patterns from each side of the family to determine which tests are most appropriate to order.”
The test is typically a simple blood draw, although it also can be done using saliva. The sample goes to a lab to be tested for genetic mutations that could predispose the patient to cancer.
Parish said many cancers can have a genetic component, and scientists regularly discover new gene mutations to test for.
“People are most familiar with the BRCA1 and BRCA2 gene mutations and their association with increased breast cancer risk, but there are many other genes associated with cancer risk,” she said, including genes related to colon, kidney, stomach, uterine cancer, etc.
Furthermore, she said, “Often, if a gene mutation puts you at risk for one type of cancer, it puts you at risk for multiple types of cancer. BRCA1 and BRCA2 variants aren’t just linked to increased breast cancer risk, but also to ovarian, pancreatic, and prostate cancer.”
For patients and doctors, that knowledge is powerful.
“If they have a genetic mutation, we discuss the implications,” Parish said. “We may offer different medications than we would for patients without the mutation or discuss risk-reducing surgeries. Sometimes the patient requires increased surveillance – we order scans more frequently to follow them more closely and look for cancer.”
Parish also offers “cascade testing,” where family members of a patient with a genetic mutation are tested to see if they are at higher risk of cancer and in need of treatment or surveillance.
“Genetic testing has had a big impact on outcomes,” Parish said. “The hardest thing is telling a patient they have cancer that is already very advanced. Survival is better when you identify cancer very early or prevent it in the first place – and that’s what genetic testing helps us do.”
For more, contact Regional One Health Cancer Care at 901.515.HOPE (4673).
By Kelly Josephsen