By: Michelle Szymanowski, RNC, MSN, WHNP-BC
Generally speaking, cancer is not a common occurrence in most families, but there are some families that have more than their share of cancer. This can be a source of anxiety and stress for some patients, but with the proper testing and management, it doesn’t have to be.
Cancers can be divided into 3 types of occurrences: sporadic, familial, and hereditary:
• Sporadic cancers are cancers that occur randomly or may be environmentally related. This may be a single family member who has had lung cancer related to smoking, cervical cancers related to HPV or a single family member with breast cancer. Sporadic cancers usually happen only to one family member or they may be explainable due to an environmental cause.
• Familial cancers are cancers that run in families but do not appear to be genetic related. These cancers do not seem to be passed from parent to child. They may be from a gene that we are not yet familiar with. They may be from reasons that we do not yet understand.
• Hereditary cancers are cancers that are related to a specific gene. These genes are passed from parent to child. Families with hereditary cancers tend to see the same types of cancers in their families. Hereditary cancers tend to occur at younger ages in families than what we would expect to see. These cancers can include young breast cancers, young colon cancers or ovarian cancer at any age. Individuals who have these hereditary genes may develop more than one cancer in their lifetime. Additionally, individuals who carry these genes have a 50 percent chance of passing the gene on to each of their children. It is important to identify patients who carry these hereditary genes so that they can be managed according to their individualized needs based on their genetic findings.
Determining which type of cancer pattern that your family has can help determine the best course of care in planning your health management. Genetic testing is an easy way to determine what type of risk you have and can help to determine an individualized plan of care for you to either decrease your risk of cancer or to detect it in its very early stages. Early detection is important because research has shown that the earlier cancers are identified and treated, the better outcome we can expect for an affected individual.
There are 8 types of cancers that we look for in families that may be related to genetics; we call these genes, “clinically actionable”. Clinically actionable means that we have the ability to screen early for these types of cancers, or prevent them all together; it means that there is an action that we can take to manage a patient’s risk. If your family has a history of breast, ovarian, endometrial, colon, pancreatic, gastric, melanoma, or prostate cancer, you may qualify for a test that can determine whether or not your family carries a gene that may increase your risk of developing cancer.
Even if you have a relative who was tested for the BRCA genes and was negative, your family could have a gene that increases your risk. Patients tested prior to 2013 tended to be tested only for one or two genes. Panel testing has now given us the ability to test for additional genes that have since been determined to increase a patient’s risk of cancers. We recommend that anyone who was tested prior to 2013 or is relying on a family member’s test that was done prior to 2013 have a panel test done. It is important to speak to your family members to determine what type of testing they had done and to share that information with your healthcare provider.
Our genes are what make each of us unique; they are a wonderful source of our individuality. They determine our eye color, our gender and sometimes our risk of certain types of cancers. Genes that increase our risk of cancers are not necessarily bad and it doesn’t mean that there is a certainty that a patient will get cancer, but it does help us to determine which patients should be more closely monitored. When a patient and her health care provider knows that she has a gene that increases her risk of certain types of cancers, they can make decisions together that can decrease her risk of these cancers. These decisions can include very simple decisions such as what type of birth control is best for her or what early screening options are available to her. Sometimes they may include more complicated decisions including surgical options.
Knowing a patient’s genetic status can help with medical management and decision making. It can help us determine if it is better for a patient to have an IUD (Intrauterine Device), or use birth control pills for contraception. It can help to determine whether or not she is a candidate for certain types of surgeries such as endometrial ablation, tubal ligations or even hysterectomy. It can also determine what the most effective screening methods and frequency of screenings are that is specific to each patient.
As an example, patients who carry certain genes may need mammograms at age 25 rather than 40, or colonoscopies at age 25 rather than 50. Patients who are at risk for breast cancer may need a yearly MRI in addition to their mammograms. Knowing your genetic status can help determine if you should have these exams earlier than what is recommended for the general population.
Most insurances now cover genetic testing for patients who meet the proper testing criteria. Additionally, there are federal laws in place that protect patients from discrimination. Neither insurers nor employers may discriminate against a patient for having had the test or for having had a positive test result. You cannot be denied insurance or be charged a higher premium for your insurance based on your genetic status.
If you have a family history of cancers or if you are worried about your risk of cancers, please speak to your nurse practitioner or to your physician so that we can help you determine if genetic testing is an option for you.