Genetic Testing Can Help Determine Risks for Certain Cancers

Knowing your risks for certain cancers can empower you to make the best decisions about your health care.

Kathy Milam, certified nurse practitioner with Mercy Clinic Oncology – Fort Smith, said genetic testing is rapidly changing and becoming more advanced each year, meaning more mutations can be detected. Milam recently presented information on genetic testing during a Reynolds Cancer Support House virtual learning session.

“When a patient is diagnosed with a certain type of cancer, we like to do genetic testing to determine the cause of their cancer and to determine their likelihood of recurrent disease or the possibility of developing another cancer,” she said. “We also do genetic testing for family members of patients who have tested positive for the mutation to determine their risk of developing cancer and hopefully preventing cancer from occurring or catching it early and increasing their survival rate.”

Mercy can evaluate a patient’s family history and other factors to determine whether they’re a candidate for genetic counseling or testing. If the patient’s personal or family history shows a risk for inherited cancers, they can be referred to the cancer genetic risk assessment provider. The genetic provider will recommend the type and timing of genetic testing that’s best for the patient and their family.

What happens if tests are positive? For many, it could mean potentially finding cancers earlier during more frequent checkups. Chemoprevention – the use of medications to help prevent disease – may be recommended in some cases.

“If you’ve tested positive for a genetic mutation, then we can pursue close surveillance in hopes of detecting the cancer early at a more treatable stage,” Milam said.

A positive result can mean more to the patient on a different level.

“A lot of times when patients are found to be positive, there’s a lot of anxiety, depression and guilt that they’ve possibly passed on this gene mutation to their children,” Milam said. “We’ll sit down and talk about the possible results, how to discuss this with your family members, especially your children, and whether they need to be tested. We will look at the implications of what would happen with positive results. Of course, what we hope for are negative results.”

Currently, Mercy can test for 84 gene mutations associated with hereditary cancers, Milam said. The most common types of hereditary cancers include breast and ovarian cancer, colon and endometrial cancer and prostate cancer.

Genetic testing may be considered for anyone who:

• Has had breast, colon or uterine cancer diagnosed by age 50 or a family member diagnosed.
• Has had cancer in a set of pair organs such as kidneys or breasts.
• Has had ovarian cancer, pancreatic cancer or a high-risk prostate cancer (Gleason score of 7 or greater).
• Has had 10 or more gastrointestinal polyps found during a colonoscopy.
• Is of Ashkenazi Jewish heritage.

Patients undergo genetic pre-counseling sessions to see if they qualify for testing. During this phase, the patient’s family history is examined.

“We start off with your history, then we move on to cancer history of first degree relative such as your parents, children and full siblings,” Milam said. “Then we’ll move on to cancer histories of second-degree relatives such as aunts, uncles, nieces, nephews, grandparents, grandchildren and half siblings. We’ll look at your ethnicity and any use of hormones with females, as well as any previous genetic testing.”

A patient may qualify to test for all 84 genes depending on the types of cancers Mercy identifies, Milam added.

Cost and insurance concerns are also discussed during the counseling session. Out-of-pocket costs usually are no more than $100, while those without insurance can still have genetic testing performed for around $250. Medicare and Medicaid are accepted.

Although direct consumer testing is now available, the testing equipment used is less accurate than what Mercy has available. Milam gave the example of a female patient who tested positive for the BRCA breast cancer mutation through direct consumer testing despite little family history. She later received negative results after genetic testing through Mercy.

For information on genetic testing, call Mercy Clinic Oncology – Fort Smith at 479-314-7490.