Hereditary Cancer Assessment

Many people worry about being diagnosed with cancer, especially if close relatives have had cancer. Although most cancers are not hereditary, in some families a predisposition to cancer can be passed down from one generation to the next – from either parent.

Determining if the cancer in your family is sporadic, familial or hereditary can provide you with the information you need to create a plan for early detection and/or reducing the risk of developing cancer. A better understanding of your cancer risk can also provide peace of mind.

A complete hereditary cancer assessment includes counseling from one of Hoag’s certified genetic counselors, in addition to genetic testing.

What is genetic testing?

Genetic testing for hereditary cancer susceptibility usually involves just a simple blood draw or saliva sample. All tests are performed at outside laboratories. The results of these tests can help determine if you are at risk for hereditary cancers.

When it is suspected that an individual may have a hereditary risk for breast or ovarian cancer, BRCA testing is performed. BRCA testing is done to test for a mutation in the BRCA1 or BRCA2 (BReastCAncer) genes, which can cause Hereditary Breast and Ovarian Cancer (HBOC) Syndrome. This syndrome substantially increases the risk for developing breast and ovarian cancer. Depending on the cancer history in the family, we might also discuss testing for other breast cancer genes.

For individuals or families with other types of cancer, for example of the colon, uterus, stomach, kidney, pancreas or brain, we will order DNA testing for the appropriate genes pertaining to those cancers.

Organizations such as American Cancer Society, National Cancer Institute, American Society of Clinical Oncology and the U.S. Preventive Services Task Force recommend that genetic testing be done only after consultation with a genetics professional.

A genetic counselor can help you decide if testing is indicated, which test is appropriate and the best approach for testing in your family. Genetic test results are often complex, and should therefore be interpreted by a specialist who can also provide emotional support, assistance in informing family members, and help in developing a plan for cancer screening and risk reduction.

Who should consider hereditary cancer assessment?

If you or a close family member have had any of the following, a hereditary cancer assessment may be important for you:

Hereditary Breast/Ovarian Cancer

  • Breast cancer under age 40-50
  • Ovarian cancer at any age
  • Breast and ovarian cancer in an individual or family
  • Male breast cancer
  • Breast, ovarian or pancreatic cancer in an Ashkenazi (Eastern European ancestry) Jewish family
  • Metastatic prostate cancer

Learn more about Hereditary Breast Cancer genetic counseling at the Hoag Breast Center site.‚Äč

Hereditary Colon Cancer

  • Colorectal cancer under age 50
  • Endometrial (uterine) cancer under age 50
  • Multiple colon polyps
  • More than one of the following cancers in an individual or family, especially under age 50: colon, rectal, endometrial, gastric, ovarian, pancreas, ureter/renal pelvis, biliary tract, small bowel, brain, and sebaceous adenoma/carcinoma.

Other Hereditary Cancer Conditions

  • Multiple family members with the same type of cancer (for example, stomach, pancreatic, kidney, melanoma, brain, bladder and prostate)
  • Younger than average age at diagnosis (for example, stomach cancer at age 45)
  • Individuals with more than one type of primary cancer (e.g. cancer in both kidneys), especially if the first diagnosis was under age 50
  • Anyone with paraganglioma, medullary thyroid cancer, adrenocortical carcinoma, pheochromocytoma, retinoblastoma or Wilms tumor
  • Metastatic prostate cancer

What is involved in an assessment?

Family History form and Helpful hints for completing the Family History form

What will happen at the appointment?

Please allow approximately one hour for your initial meeting with the genetic counselor. If testing is performed, then it may take another 15-20 minutes for your blood draw. Blood draw is our preferred method of sample collection, but we can make exceptions by collecting saliva (please note that with some tests, the saliva option is not possible). At the time of your appointment, you will check in at the front desk at either the Hpag Family Cancer Institute in Newport Beach, or the office location in Irvine, and you will be directed to register (even if you have pre-registered). After your registration is complete, a genetic counselor will meet with you to review your personal and family history.

The genetic counselor is there to:

  • Listen: What are your concerns?
  • Provide education: Explain the complexities of hereditary cancer, risks, genetic testing and implications of test results
  • Analyze family: Are you at higher risk for cancer? Is there any genetic testing or research study that might be useful for your family? Who is the best person to test in your family?
  • Testing: Arrange for testing, if appropriate. Do you want to have genetic testing? It’s OK not to test!
  • Informed consent: Explain the benefits and limitations of genetic testing and answer any questions you may have about the process
  • Results: You will most likely be scheduled for a results appointment, usually one to two weeks after your blood draw. Please note that some tests may take longer than two weeks. Your results appointment will usually take no more than 30 minutes.
  • Support: Discuss how to talk about this information with family, provide information on support groups, registries and resources
  • Provide Summary Letter: A report will be sent to you and your referring physician summarizing your consultation and test results (if test is done)
  • Answer your questions

How to prepare for your appointment

The most important thing you can do to prepare for your appointment is to gather accurate information about your family and send it to us before your appointment (by the date requested in your appointment letter). Please take time to fill out a Family history form. Click here for instructions on how to fill out the Family history form. Accurate family history and medical records provide valuable information that we will use in your evaluation and it may help us decide if any testing is appropriate for you (remember, it’s OK not to test!).

  • Gather your medical records. If you’ve had cancer, please try to obtain medical records of your diagnosis, especially pathology reports. If your diagnosis was through Hoag, we may be able to obtain your records from our system.
  • Gather medical records of your family members who have had cancer. If pathology reports (records of cancer diagnosis) are not available and your relative is deceased, sometimes death certificates are useful if your relative died of cancer and if you are not sure what type of cancer he or she had. These websites may be helpful in obtaining a death certificate:

  • Get copies of any gene test results. If you or any of your family members have already had genetic testing related to a hereditary cancer syndrome, please obtain a copy of the results (with the permission of your family member, of course) and send to our office along with your family history form prior to your appointment. It is best to return your family history form to us at least one week prior to your appointment.
  • Make a list of questions to ask the genetic counselor.

Please allow approximately one hour for your consultation with the genetic counselor. If testing is performed, then it may take another 15-20 minutes for your blood draw.

You do not need to fast for your blood draw, but if you wish to have a saliva test instead, we ask that you not have anything to eat or drink one hour before the appointment. Blood draw is our preferred method of sample collection, but we can make exceptions (please note that with some tests, the saliva option is not possible).

You may find it helpful to bring a support person – family member or friend – because a lot of information is discussed at our appointment. A second person may help remember the discussion as well as provide emotional support.

After your appointment?

Within a few days of your final appointment, you should receive a detailed summary letter from us along with the map of your family that we created together.

Click here for a key to the symbols used in your family map.

Going forward, please keep in touch with us, since cancer genetics is a field with frequent new developments, and we know that family histories can change, too.

Please feel free to call us to discuss any of the following:

  • Have there been any new discoveries in genetics that result in additional testing that would be appropriate for me?
  • Are there any changes in medical management guidelines that might affect me?
  • Are there any research opportunities for my family?
  • My sister was just diagnosed with cancer. Does that change my assessment?
  • My address and/or phone number has changed.