FORCANCER - Moores Cancer Center

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GENETIC TESTING Is it right for you? Cancer Genetics Service Now Available Cancer touches almost every family. It’s not unusual to know of a parent, grandparent, aunt or uncle who has cancer. But when several family members are affected, it may indicate a hereditary susceptibility to cancer. While only a small percentage of cancers are associated with an inherited genetic mutation, people with these mutations can have a lifetime risk of developing cancer that is significantly higher than that of the general population. For example, a woman’s average lifetime risk of developing breast cancer is 12 percent. If she carries a mutation in one of the currently known breast cancer genes — BRCA1 or BRCA2 — her lifetime risk may be as high as 85 percent. Mutations in these genes also confer an increased risk for ovarian cancer. Average lifetime risk for ovarian cancer is 1.4 percent in the general population, but may be as high as 15 to 40 percent in women with changes in BRCA1 or 2. Alterations in the breast cancer genes are also associated with a somewhat increased risk for colon and pancreatic cancer in men and women, and an increased risk of prostate cancer and breast cancer in men. Not all people with changes in these genes go on to develop cancer, however. Knowledge is Key “Genetic counseling and testing may provide important information to people with a family history of cancer who are concerned about their cancer risk,” said Linda Wasserman, M.D., Ph.D., director of the Cancer Center’s Clinical Cancer Genetics Unit. “This kind of information affects the whole family and so we encourage that spouses, siblings and adult children be involved, if that fits with a particular family. Often, individuals considering genetic testing for themselves will wish to discuss the issues involved in testing with their family. When this is the case, involving everyone in the counseling process provides an opportunity for all to hear the same information and discuss the issues together. However, all patients are given the option of privacy.” Genetic privacy with regard to insurance companies and employers are a concern of many patients. Ways to safeguard privacy and confidentiality are carefully discussed with each patient. The Clinical Cancer Genetics Unit provides its counseling and assessment services at no charge. If a patient decides to proceed with genetic testing, the cost can vary from $500 to $2700, depending on the particular genetic test. Many health plans now provide coverage for such testing. “Counseling is a critical component of genetic testing for cancer susceptibility,” said Eric Rosenthal, Ph.D., M.S., the Clinical Cancer Genetics Unit genetic counselor. “Along with a careful review of the individual’s personal and family history of cancer, it is important to discuss the potential benefits and risks of genetic testing to determine if this information is going to be helpful to the individual.” For those who are concerned about their cancer risk, it is important to get as much information as possible UCSD Cancer Center News 4
about their family tree and the exact kinds of cancers that have affected relatives. A Cancer History “Our assessments are most useful when we know the history of cancer in all the blood relatives. That includes parents, grandparents, siblings, children, grandchildren, aunts, uncles and cousins,” said Rosenthal. “We need to know what types of cancers family members had, and the ages at which they were diagnosed.” The team assesses this family history to help determine whether the history suggests a heritable risk, whether the types of cancers in affected family members is consistent with known syndromes for which genetic testing might be available, and the degree of cancer risk of unaffected family members. When genetic testing is appropriate, the team arranges for the testing. Based upon the test results, team members will develop an individualized risk management plan. The plan may include recommendations for: ■ Monitoring or screening for early detection of cancer ■ Prophylactic surgery ■ Changes in diet and exercise ■ Lifestyle modifications, such as ceasing smoking ■ Clinical trials in cancer prevention For further information about the services of the Clinical Cancer Genetics Unit at UCSD Cancer Center, please call Eric Rosenthal at (858) 657-7066. Linda Wasserman, M.D., Ph.D. Dr. Wasserman, Assistant Professor of Clinical Medicine, is director of the Cancer Center’s Clinical Cancer Genetics Unit, and of the Molecular Genetics Laboratory in the Division of Medical Genetics. She also heads the DNA Sequencing and the Molecular Pathology Shared Resources; these are large laboratories that provide sophisticated technical services to researchers throughout the Cancer Center. Her own research focuses on the relationship between genetic differences in estrogen metabolism and breast cancer, and on the detection and quantification of circulating breast cancer cells in peripheral blood. She received her Ph.D. in psychology from UCLA and was a practicing psychologist for 15 years before attending medical school at UCSD. She did her residency in anatomic pathology at UCSD and a postdoctoral fellowship in molecular oncology, funded by the American Cancer Society, at the Ludwig Institute for Cancer Research. .Eric Rosenthal, Ph.D., M.S. Rosenthal recently joined the UCSD Cancer Center as a board certified genetic counselor in the Clinical Cancer Genetics Unit. Before coming to UCSD he provided genetic counseling for participants in a clinical genetics research program at the University of Utah. He is a graduate of a genetic counseling training program jointly directed by Johns Hopkins University and the National Human Genome Research Institute of the NIH. He received his Ph.D. in Cell and Developmental Biology from Harvard University and worked as a research biologist for nine years before becoming a genetic counselor. His current research interests involve issues of how individuals and families cope with genetic disorders and how health care providers can more effectively meet their needs. ARE YOU AT RISK? Family histories with one or more of the following features may suggest a hereditary cancer risk: ■ Cancers diagnosed at unusually young ages, such as breast cancer under age 40, or colorectal cancer under age 55 ■ Three or more affected individuals across two generations ■ Individuals diagnosed with more than one primary cancer — additional cancers that are not a recurrence or metastasis of an earlier tumor ■ Unusual cancers, such as breast cancer in a male 5 UCSD Cancer Center News
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FORCANCER - Moores Cancer Center

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