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