Genetic Cancer Counseling & Tests
Genetic counseling and testing at the Swedish Cancer Institute’s Hereditary Cancer Clinic can help determine your risk and your family members' risks for developing hereditary cancers including (but not limited to) breast, ovarian and colon cancers. Patients and family members meet with a board-certified genetic counselor who will review medical and family histories to determine which genetic tests are appropriate, as well as the risks, advantages and costs of genetic testing for hereditary cancers.
Genetic Counseling and Testing for Hereditary Breast/Ovarian Cancer
Several genes may predispose a woman toward breast/ovarian cancer, though the most commonly tested genes are called BRCA1 and BRCA2. In the video below, Robert Resta, a Genetic Counselor, provides overview of genetic testing specifically for breast cancer.
Genetic Counseling and Testing for Colorectal Cancer
Swedish Cancer Institute’s Hereditary Cancer Clinic focuses on patients and families at risk for hereditary colorectal cancers. The results of genetic testing can significantly influence a patient’s treatment plan, as well as indicate appropriate screening tests and medical procedures for relatives who may be at risk of cancer.
Benefits of genetic testing
The results of genetic testing can help patients and their physicians develop an appropriate treatment plan, as well as indicate appropriate screening tests and medical procedures for relatives who may be at risk of cancer. The genetic counselor works closely with oncologists, surgeons and other cancer specialists to help integrate the genetic-test results into patient care and surveillance for cancer.
What to expect
Patients and family members meet with a board-certified genetic counselor – a health professional with specialized training in genetics, medicine, risk assessment and counseling. The appointment usually lasts 30-90 minutes. Testing usually requires a simple blood draw. The analysis is usually performed at Myriad Genetic Laboratories, a Utah-based laboratory that has extensive experience with BRCA testing. Results usually take about two weeks. All results are confidential.
Genetic Testing, DNA Banking Benefit Survivors and Families
The Hereditary Cancer clinic can help cancer survivors and their relatives learn of their risk for hereditary cancers - particularly breast, ovarian and colon cancers. If you are a cancer survivor and had a hereditary cancer, then you may be at increased risk of developing another cancer, and your family could also be at risk.
Using breast cancer as an example, a survivor whose cancer was not hereditary has a 5 percent risk of developing a new, second breast cancer. If, however, the initial breast cancer was hereditary, as determined by family history and genetic testing, then there is a 30-40 percent chance of a new, second breast cancer developing.
The gene mutations that cause breast cancer also boost the risk of ovarian cancer to 40 percent, as opposed to a 2 percent risk in the general population. "Five percent to 10 percent of women or men with breast cancer have a hereditary component," says Robert Resta, Swedish Cancer Institute’s Genetic Counselor, "and there are a half-dozen genes that can lead to breast cancer. We can test for these genes, if the tests are appropriate based on your family or medical history."
Genetic testing usually involves a routine blood draw. Although genetic testing is expensive, it is covered by many health insurers, including Medicare. The results of genetic testing can indicate appropriate screening tests and preventative measures for anyone determined to be at increased risk of developing additional cancers.
For other types of cancer — such as prostate, lung, or leukemia - there are no reliable genetic markers at the present time, nor are there any reliable screening tests to detect the cancers at an early and treatable stage. Research continues, however, with the goal of discovering more genetic markers and developing a new generation of screening tests. Because of ongoing genetic research, survivors of any kind of cancer may want to consider having their DNA banked. If you have had cancer and there are no current genetic markers, your family can use your DNA for testing when new genetic markers are identified in the future. DNA banking is one of the best gifts that you can give your children and grandchildren. This can help future generations accurately determine their cancer risk and take measures to reduce that risk. DNA banking, like testing, only involves a simple blood draw, and is relatively inexpensive.
I'm Bob Resta a certified genetic counselor at Swedish Cancer Institute at Swedish Medical Center in Seattle. Your doctors at Swedish want you to have the best information possible about breast cancer to help you manage your life and make the most informed healthcare decisions.
In this podcast we will discuss the genetic counseling services available for breast cancer patients and their families at the Swedish Cancer Institute. I will also talk about what to expect from a genetic counseling session for breast cancer and continue by answering some of the most frequently asked questions about genetic testing and breast cancer. We hope that this podcast will help answer some of your questions and encourage new questions for when you meet with the genetic counselor the Swedish Cancer Institute.
About ten percent of all breast cancer has a significant hereditary component usually related to two mutations in jeans called BRCA one and BRCA two. Genetic testing involves a blood test that looks for changes in these genes. The results of a genetic test can help determine the chance of developing or passing on certain inherited forms of breast cancer. It can also guide your doctors in making medical recommendations for preventing, detecting, and treating breast cancer. Genetic testing is also available for some forms of ovarian cancer, colon cancer, and some other rare cancer syndromes.
Many patients are interested in genetic testing but they do not know if they are high enough risk to warrant testing. A genetic counselor can help you decide which gene test, if any, is right for you based on your family and medical history.
One question people often ask is what is the cost of genetic testing services and will my insurance cover it. Genetic counseling and genetic testing are billed separately. The consultation typically costs about $220. Many, but not all, insurance companies cover the consultation. Currently, genetic counseling is not covered by medicaid or medicare. You should check with your insurer to see if genetic counselor are covered or if your insurance provider contracts with Swedish Medical Center. For patients who pay out of pocket at the time of service, we offer a discount of about thirty-five percent. Genetic testing can be fairly expensive, around $3,100. Although most insurance companies, including medicaid and medicare, cover genetic testing, the amount of coverage varies from plan to plan. Fortunately, the laboratory will verify your insurance coverage before any tests are run on your blood sample and you will be contacted if your insurance does not cover it.
Many patients want to know what they can do to prepare for their appointment. For patients receiving their care at Swedish Medical Center, your medical chart will usually be available for the genetic counselor to review. For patients outside the Swedish system, make sure your health care provider sends copies of your records. prior to your appointment. All patients should also learn as much information as possible about both sides of their family, including children, siblings, nieces, nephews, parents, grandparents, aunts and uncles, and cousins. Important information to collect from your relatives, as much as reasonably possible, is their current age or age at death and their general health status. Particularly critical information to learn about relatives who have had cancer is if the cancer started in that organ or if it spread to that organ from somewhere else. Finally, you should find out the approximate age at which they were diagnosed with cancer. When you come to the appointment the genetic counselor will review your medical and family history and then they will determine which tests are appropriate for you.
Next, your genetic counselor will discuss how the results may affect your medical care, explain how the results may be interpreted, and explore the implications of your test results for your entire family. Laslty, your genetic counselor will address any questions you may have. You are welcome to take notes or use a tape recorder.
Be prepared to spend about one hour with your genetic counselor. Relatives and friends are welcome to attend and often provide helpful support in family health history. Remember that we will address some very personal medical matters so be sure that you feel comfortable discussing this information in front of whoever comes with you.
You can choose to get your blood drawn at a Swedish lab the same day as your consultation or another day. Expect to spend an extra half-hour if you do it on the same day as the consultation. Usually only a tube or two of blood is all that's necessary for the test. No special preparation is needed for the blood draw. Most tests are run at Myriad Genetic Laboratories in Salt Lake City, Utah. It usually takes about two to three weeks to get your results, though sometimes insurance approval might delay results. All test results and consultation notes are confidential and will only be shared with your health care providers that you identify. You can you receive the results in person or over the phone depending on your preference. This will be followed up with a mailed copy of your results and a summary letter.
One of the main concerns patients have about genetic testing is that they will get dropped from their insurance if they test positive for a gene mutation. Fortunately, a federal law called the Genetic Information Non-discrimination Act, or GINA prohibits health insurance and using genetic information to decide if they will cover you, if they will continue to cover you, or how much they will charge you. The law applies to individual and group policies. It also covers you if you switch health plans.
Genetic testing can have emotional effects but they vary from person to person. Many people find their genetic test results empowering. It helps them understand why they may have developed cancer, what they can do to prevent cancer, and how cancer may affect their siblings, children, and other relatives. However, some patients may find it overwhelming to discuss the implications for their health and the health of their family. You should make sure that you are emotionally ready to explore these issues.
The error rate of a postive genetic test is very very low. Sometimes, however, the laboratory detects a rare genetic variant that may be of uncertain significance. It is also important to remember that new genetic tests are likely to become available in the future, so some families that test negative by today's test may test positive if new tests are developed in the future.
In conclusion, genetic counseling and testing can be important and useful for those affected by or at risk for breast cancer. We encourage you to thoughtfully consider what I discussed today if you're thinking about genetic testing.
For further information please visit the swedish Cancer Education Center located in the Arnold Pavilion on A Floor West or call 206-386-3200. Thank you for listening to the Plugged in to Your Health cancer podcast program Genetic Counseling and Breast Cancer series. Thank you.
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