Hereditary Cancer: Genetic Counseling and Testing

Risk evaluation for individuals with a personal or family history of cancer.

Is cancer a genetic condition?

Cancer results from an accumulation of genetic changes within a cell that allow uncontrolled cell growth. In the vast majority of cancers, these changes are not inherited but occur after birth due to certain environmental agents. Occasionally, families have a very strong cancer history suggesting that a major inherited cancer predisposition gene is responsible. The most common inherited cancers include breast, ovarian and colon, although other types exist.

Who might have a genetic predisposition to cancer?

The characteristics of families genetically prone to cancer include an early age at diagnosis, bilateral tumors and cancers that have affected multiple generations. Indications for a Cancer Genetics Evaluation include:

Breast and Ovarian Cancer

• If you or a close relative had breast cancer prior to age 50.
• If you or a close relative had ovarian cancer at any age.
• If you or a close relative had triple negative breast cancer prior to age 60.
• You and two or more close relatives had breast and/or ovarian cancer at any age.
• Any male who has had breast cancer or a close relative of a male with breast cancer at any age.
• Pancreatic cancer with breast or ovarian cancer present on the same side of the family.
• You are of Ashkenazi Jewish descent and had breast or ovarian cancer at any age.
• You have a close relative with an identified BRCA1 or BRCA2 mutation.

Colorectal Cancer

• You had colon or uterine cancer prior to age 50.
• You had two separate colon cancers or both colon and uterine cancer at any age.
• You have two close relatives with colon cancer, with at least one diagnosed before 55.
• You have three close relatives with colon and/or uterine cancer at any age.
• You or a close relative have been diagnosed with polyposis.

Other Cancer Syndromes

• You or your close relatives have a history of multiple primary tumors at early ages.
• You have many close relatives with cancer diagnosed before age 50.

Who should consider genetic testing?

Genetic testing is not for everyone. After a family history risk assessment, individuals who have a reasonable likelihood of being genetically predisposed to cancer are offered genetic testing. Prior to testing, individuals will learn the significance and implications of the possible test results to be sure they are making an informed choice about testing.

Genetic testing may help clarify cancer risks for an individual and his or her family members, as well as allow individuals to make informed decisions about their clinical cancer risk management.

What to expect in a genetic counseling session

Risk Assessment – The genetic counselor will take a complete family history and medical history. It may be necessary to review medical records.

Genetic Counseling – Includes learning about the genetics of hereditary cancer, risk assessment and genetic testing. This phase of the genetic counseling session may involve identifying and coping with the psychological and social concerns related to an increased cancer risk. It also consists of discussions about decision making and familial implications of hereditary cancer and genetic testing.

Genetic Testing – Genetic tests and/or participation in research studies are offered if appropriate. Deciding whether or not to have genetic testing is a personal choice that can be discussed with the genetic counselor.

Test Results – Individuals who pursue genetic testing may be asked to return for a second session to discuss the results and possible management strategies. Genetic risks to family members are reassessed based on the genetic test results.

Risk Reduction Strategies – Discussion of surveillance and preventative measures will vary depending on the type of cancer, genetic test results and personal and medical family history. Options may include intensive monitoring, medications and surgery. Referrals to appropriate medical specialists are made as needed. Some individuals also find referrals to professional counseling services and/or support groups helpful.

Does insurance cover genetic testing?

Most insurance plans cover genetic testing if certain insurance criteria are met. The genetic counselor will determine whether you meet your insurance plan’s criteria for any appropriate genetic testing. For most genetic testing, the testing laboratory will contact you regarding any significant out-of-pocket expense for your approval before beginning the test. For more information about genetic counseling and testing, please call 865-374-TCSC (8272) for a free education packet.

Making appointments and referrals

To schedule an appointment or to make a referral, call (865) 331-2350.