April 15, 2013
Cancer patients: Get genetic counseling before testing
BY Mark Lewis, M.D.
Individuals with a history of cancer in their family often seek out testing to learn if they, too, carry a gene that might indicate a future cancer diagnosis.
That's certainly true for me. My father, a non-smoker, was diagnosed with a very rare lung cancer when I was 8 years old.
When I got older and began researching facts about my father's cancer, I learned that in my family there exists a cancer syndrome called multiple endocrine neoplasia type 1 (MEN-1) syndrome that makes us more likely to develop tumors on our endocrine glands.
I've had non-malignant tumors in my pituitary and parathyroid glands, as well as my pancreas.
I get screened every year to make sure my tumors are behaving. Because I'm an oncologist, I can keep a vigilant eye on my own health. I can also share this information with my children when they get older because it's possible that our family history could play an important role in their health, and they'll want to share that information with their own doctors.
It's important to keep in mind that most cancers are the result of lifestyle choices and not family history.
Learn your family history
Certain types of cancers, such as breast, ovarian, prostate and colon are more likely than many other cancers to be the result of a gene you inherited from one of your parents, but even then it's not necessarily true that cancer "runs in your family."
Before you consider genetic testing, you want to review your family tree and find out certain factors.
A parent or sibling who had cancer before the age of 50, male breast cancer and two or more cancers in the same person are all examples of cancers that might have a genetic link.
The importance of genetic counseling
I also believe it's critical that anyone who considers genetic testing first seek out genetic counseling. Counselors can help explain what genetic counseling can and can't do.
We are only beginning to understand family links in certain types of cancers, although we're aware of the significance of family history in many others, such as breast, ovarian, prostate and colon.
It's terrific that we've become so educated in the role of family history with respect to these and other cancers, but it also means that people are seeking more information and want to know if they'll be diagnosed with cancer and when.
It's important to tell your counselor and your physician everything you know about your family's medical history and to be as specific as possible. For example, having a grandparent that passed away of cancer is good information, but it's better if you can tell the kind of cancer that grandparent had and their age at the time of diagnosis.
Your counselor will review all your information and can discuss the odds of your being at greater risk for developing cancer.
Choosing to take action
That's when you have to decide what to do with this information. Remember, genetic testing won't reveal that you will or will not receive a cancer diagnosis in your future. It will simply tell you if you're at a greater risk, or if you're carrying a gene that is linked to certain types of cancers.
You probably want to spend some time thinking about and discussing with your family what your choice will be. Would you want to have your breasts and ovaries removed as a precaution? Or, would you prefer to deal with a cancer diagnosis when - or if - it comes, knowing that you might spend a great deal of time worrying about it?
Some people choose not to have a genetic test done at all, and choose to live their life without knowing it they are at greater risk. That's fine, too. We all have to be comfortable in the future with the decisions we make today.
I would never recommend genetic testing without first going through genetic counseling to get a true picture of what you may or may not learn. When it comes to genetic testing, there isn't a "right" decision. There's only a "right" decision for you.
Dr. Mark Lewis is an medical oncologist at MD Anderson in Sugar Land's regional care center. As a general hematologist and medical oncologist, his clinical interests include breast, colon, head & neck, and lung cancers, as well as cancers running in families.
I would never recommend genetic testing without first going through genetic counseling to get a true picture of what you may or may not learn.
Mark Lewis, M.D.