Cancer Risk Assessment & Genetic Counseling

MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I'm Deborah Howell, and today we'll be speaking with two experts about cancer risk assessment and the role of genetic counseling. Maggie McDuffe is a board certified genetic counselor who joined MemorialCare in 2016, Taylor Cain is also a board-certified genetic counselor who recently joined MemorialCare in November of 2019. They both provide counseling services at Orange Coast Medical Center and Saddleback Medical Center. Welcome, Maggie and Taylor.

Taylor Cain, MS, CGC: Thank you, Deborah.

Deborah Howell (Host): Taylor, let's begin with you. Why would a patient be referred for genetic testing?

Taylor Cain, MS, CGC: So a doctor might refer a patient for testing if they wanna rule out the possibility of a hereditary cancer syndrome. So while most cancers are sporadic occurrences, we think about five to 10% of cancers are hereditary, meaning that a family carries a genetic change or a mutation that can cause an increased risk for certain cancers. So some reasons why a patient or doctor might wanna rule this out is if somebody has a cancer diagnosed at an early age, if someone has more than one cancer, if they have had rare types of cancers or more than one family member with the same or related type of cancer.

Deborah Howell (Host): And what's the process of requesting a genetic counseling appointment at MemorialCare Cancer Institute?

Taylor Cain, MS, CGC: So if someone's interested in genetic counseling, we recommend that they ask for a referral from their doctor. And also, if they have HMO insurance, we would also need their doctor to submit a prior authorization to their insurance.

Deborah Howell (Host): That sounds easy enough. Maggie, what is the required training and educational background of a genetic counselor like yourself?

Maggie McDuffee, MS, CGC: So a certified genetic counselor must first complete a two-year master's program, and then they have to pass the certification exam.

Deborah Howell (Host): And how can a patient best prepare for their initial appointment with a genetic counselor?

Maggie McDuffee, MS, CGC: We usually recommend that patients do their best to talk with their relatives and try to gather information about their family's health. So specifically for a cancer genetic counseling appointment, we'd recommend that they try to find out the specific types of cancers in the family. And then if they're able to get any records, that's also very helpful. So any records of the cancer diagnosis or of any genetic testing results can also be very helpful because whatever previous test the family has had might influence what test the patient and the genetic counselor decide to order. And then one other thing that's important to mention is that a lot of people don't have a lot of information on their families. A lot of families might be very private or people might not even know their biological relatives. So if they're not able to get information, that's okay. Oftentimes a lot of genetic counselors have ways of working around a lack of information.

Deborah Howell (Host): Yeah, you use your sleuthing skills, right?

Maggie McDuffee, MS, CGC: Exactly.

Deborah Howell (Host): So what topics are typically covered in a genetic counseling appointment?

Maggie McDuffee, MS, CGC: Usually the counselor and the patient will review the patient's medical history, and they'll want to get a clear idea if the patient has had any pre-cancers, cancers, benign tumors, and any surgeries. Those are the key factors that they're looking for in the medical history. And then the counselor and the patient work together to create a family tree. And then based on all of that information, the counselor is able to give the patient a risk assessment and they can talk about the types of genetic tests that are available to the patient and what would be most appropriate. And they can talk about certain conditions that the patient and the counselor might want to rule out. And then they definitely go over the pros and cons of genetic testing.

Deborah Howell (Host): Now, Taylor, I'd like to ask you, how can genetic counseling be helpful?

Taylor Cain, MS, CGC: Yeah, it can be helpful in many different aspects. And so for one thing, it can help inform people about what are the chances to develop cancer and what we do about that. And so if somebody is found to have an increased chance to develop cancer, these results can empower people to pursue increased surveillance or preventative measures and take actions like that. If somebody's already had cancer, genetic testing can also help determine whether somebody's diagnosis was due to an underlying hereditary cause, and it can influence surgical decisions or other treatment options, as well as it can also inform about what are the chances to develop another cancer. And this information is not only helpful for the individual themselves, but it also could have implications for family members and what they do for their management.

Deborah Howell (Host): Well, that is a helpful answer, but now the bigger question, is genetic testing covered by insurance?

Taylor Cain, MS, CGC: Many insurance companies do cover genetic testing when it's medically recommended. Each insurance company is a little bit different and has a little bit different criteria, but if insurance doesn't cover testing, testing is also available out of pocket and many labs also do have financial assistance.

Deborah Howell (Host): Good to know. And Taylor, what types of cancers could genetically be passed on?

Taylor Cain, MS, CGC: So there are many different types of cancers that can be inherited. Some common referrals might include a personal or family history of breast cancer, colon cancer, ovarian cancer, as well as many other different types of cancers. And the types of cancers that somebody could be at an increased risk for, it really depends on which gene somebody has inherited mutation in. And while many of these genes are associated with, say, one type of cancer, they could also be associated with others as well. So, breast and ovarian or colon and uterine. So, even if there is only one type of cancer in the family, it could be possible that somebody could be at an increased risk for other types of cancers as well.

Deborah Howell (Host): Oh, that's interesting. Hey Maggie, if a patient receives a positive genetic testing result, what are the next steps they should take?

Maggie McDuffee, MS, CGC: First off, we recommend that they discuss the results with their doctors. That's, you know, the key thing here, so that they can make a plan moving forward. If a patient currently has cancer, then they might be eligible for different treatment options. So sometimes there could be targeted therapies for people who carry a hereditary mutation, or it could also impact what type of surgery they decide. So, for the patients who do have cancer, it's really important that they talk with their physicians to make a plan. And then for patients who don't have cancer, a lot of times there's a lot they can do to reduce their risk. So, for instance, they're usually recommended to discuss with us and their doctors the national guidelines for whichever hereditary mutation is present. So, if there are guidelines, it might recommend that a patient could consider doing extra screenings, for instance, having earlier breast imaging or more frequent breast imaging, or if they have increased risk for colon cancer, doing earlier or more frequent colonoscopies. And then some of the guidelines might recommend that a patient think about pursuing preventive surgery. So that's also, you know, something that can be discussed. So the key here is to speak with their physicians to see if they're eligible for any extra management.

Deborah Howell (Host): Sounds good. How does a positive test result potentially affect family members of the patient and their potential risk for cancer?

Maggie McDuffee, MS, CGC: So if somebody does have a positive result, meaning that they carry a hereditary mutation that causes increased risk for cancer, then it is possible that their family members could also carry that hereditary mutation. So that's really helpful information for family members to have. Just because somebody does test positive doesn't mean that they will get cancer. But like we said before, it's helpful to know about because oftentimes there are things that they can do to reduce risk. So a lot of times patients might even feel guilty if they are found to carry a mutation. You know, they feel badly if other people in the family have it as well. But in actuality, it can be very empowering for other relatives. So if somebody has had genetic testing and they're found to, you know, discover this mutation that the family has, really they can be quite helpful in helping to prevent cancer in another family member or at least, you know, catch it at an early treatable stage. You know, it can be empowering, like Taylor said, to find out if there is a hereditary mutation. And then conversely, if a family member, let's say for instance, someone in the family has had multiple cancers or a cancer at a young age, oftentimes relatives are concerned about that. They're worried that they might get that cancer as well. So if a cause for the cancer has been identified through genetic testing and relatives can get tested for it, and if it turns out that they don't carry that, oftentimes they're able to feel relief with that result. So the knowledge can be pretty empowering no matter what the result is, even though it does present challenges as well.

Deborah Howell (Host): Knowledge is power. For more information about MemorialCare's genetic counseling services, please visit memorialcare.org/cancercare. To listen to the podcast, visit memorialcare.org/podcasts. I'm Deborah Howell. Thanks for listening and have yourself a fantastic day.