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“Patients come here concerned about developing cancer because of a family history,” explains Bridget LeGrazie, RN, MSN, AOCN, APN,c., APNG, manager of the Fox Chase Virtua (FCV) Cancer Genetics Program.“Through a comprehensive process, we assess someone’s risk for a genetic mutation and personalize an action plan to deal with the findings.”
“Identifying high-risk individuals or clusters of families is the primary goal,” explains Alan Weinstein, MD, administrative and medical director, FCV Cancer Program at Virtua Memorial. “We screen those who meet the testing criteria, then intervene to decrease the risk of developing a first cancer or catching it at the earliest stage.” Programs are now in place for breast and ovarian cancer and for colon cancer.
Maurice Cairoli, MD, Virtua medical oncologist and co-medical director of the FCV Cancer Genetics Program, describes the importance of a multidisciplinary program. “Our approach includes certified cancer genetic experts and brings together all pertinent specialists and information: patient and family histories, hormonal and environmental factors, and testing for common mutations as well as rare syndromes.”
“We educate patients and their families about the benefits and the risks of testing as well as cancer-risk prevention strategies,” explains Trina Poretta, DO, Virtua oncologist and co-medical director of the FCV Cancer Genetics Program.
The BRCA example
A case in point might be a woman at high risk for breast cancer because she is from an Ashkenazi Jewish background and has a first degree relative who developed breast cancer at age 35.
This woman would have a one in seven chance of carrying a BRCA mutation. A similar at-risk woman with a young, first degree relative with breast cancer, who is not of Ashkenazi Jewish ancestry, would have a one in 25 chance of carrying the defective genes.
Although only five to ten percent of all breast cancer cases are considered hereditary, patients with a BRCA1 or BRCA2 mutation have an increased risk for both breast and ovarian cancer. They also have a higher chance of developing a second breast cancer and need heightened surveillance such as more frequent clinical breast exams, annual breast MRI, and when appropriate, chemoprevention.
But BRCA is not the only breast cancer causing culprit– most are currently unknown. Even when a woman with a family history of breast cancer tests negative for BRCA1 or BRCA2, she is not out of harm’s way and requires careful monitoring.
Priya Gor, MD, MSCE, Virtua medical oncologist and co-medical director of the FCV Cancer Genetics Program, says: "It's difficult when there is a family history of breast cancer but a genetic test returns an inconclusive result. Patients in our program can enroll in the Fox Chase Registry and get
Annual communication about advances in genetic testing, screening and their medical management.”
Family history of breast and ovarian cancer
Through Virtua’s partnership with Fox Chase Cancer Center in Philadelphia, patients have access to the Margaret Dyson Family Risk Assessment Program for individuals with a family history of breast and/or ovarian cancer, and women who have had breast or ovarian cancer or a biopsy showing benign breast disease. The Family Risk Assessment Program provides on going studies of the biological, Genetic and environmental factors that influence cancer risk. The program responds to the rapid progress in the field of human genetics.
Inheriting colorectal cancer
“Colon cancer has four to five genes which inhibit the body’s ability to slow the progression of an adenomatous polyp to amalignancy,” according to Dr. Weinstein. In a person without the mutations, this progression might occur over a seven to ten year timeframe. In someone with the mutations, this could occur in two to three years.
Stephen Wallace, MD, Virtua medical oncologist and co-medical director of the FCV Cancer Genetics Program, explains factors that would indicate genetic counseling and testing such as: “Finding hundreds of polyps in one individual or families who present with early onset of colon or endometrial cancers.” These may implicate two of the most common hereditary colon cancer syndromes: familial Adenomatous polyposis, or Lynch Syndrome. Individuals with Lynch Syndrome are at high risk for various cancers including colon, endometrial and ovarian cancer.
Through the FCV Cancer Genetics Program, patients get the hope, support and strategies to reduce cancer risk through highly personalized care and counseling.