What can your family tree reveal about cancer risk?
Barbara Devine takes cancer personally, and her
family medical history shows why. Each generation of
her family shows a pattern of cancer including
melanoma, breast, ovarian, liver and colon cancer.
But it wasn't until she and her sister, Marie Schmaltz,
were diagnosed with breast cancer in their late 40s
that they began to think it could be hereditary.
The sisters had learned that a diagnosis of breast
cancer in women younger than 50 may indicate
hereditary risk. They considered genetic testing to
determine their risk for breast or ovarian cancer.
The sisters, however, decided against the genetic blood
test. "It was 1997, and we were afraid the results would
compromise our health insurance coverage," says
Devine. "But if we had done the test then, we would've
learned that my sister was at risk for ovarian cancer, and
she may have been able to seek preventative treatment."
Instead, Schmaltz was diagnosed with stage IV ovarian
cancer in 2002.
Her sister's diagnosis once again prompted Devine
to look into genetic testing. She contacted the Fox Chase
Virtua Health Family Risk Assessment Program (FRAP)
manager, Bridget Legrazie, MSN, RN, AOCN, APN, C,
who worked with Devine to craft a detailed "medical"
family tree, which included cancer diagnoses by type
and age of diagnosis.
Devine and Schmaltz then completed the genetic
testing they first sought in 1997. Devine's results didn't
show the type of genetic mutation that would predispose
her to breast, ovarian or other cancers. "It was a
relief to know that I didn't carry the gene, and I couldn't
pass it to my three sons," says Devine.
Her sister's results, however, showed otherwise: the
test revealed that she carried a gene that put her at high
risk for ovarian cancer. "If we learned in 1997 what
we learned in 2002, my sister might still be here today."
After her battle with ovarian and breast cancer, Schmaltz
passed away in 2004.
Learn and respond to your cancer risk
A qualified genetics nurse or counselor works with
individuals to study family medical history and risk
factors to offer personalized counseling. "I meet people
who've had cancer and people who feel they're at
risk," says LeGrazie. "Some have genetic testing done.
Others receive a cancer prevention plan that includes
aggressive screenings."
The program offers comprehensive education sessions
and individual cancer-risk counseling. Patients learn
about cancer screening methods; how pregnancy history,
hormone use, diet and other risk factors are related to
breast or ovarian cancer; about cancer patterns within the family and ways to reduce cancer risk.
According to Maurice Cairoli, MD, medical oncologist
with the Fox Chase Virtua Health Cancer Program:
"Women at high risk may need detailed mammography,
ultrasound or even breast magnetic resonance imaging
(MRI). And, since breast cancer is linked to ovarian
cancer, we recommend screenings like pelvic ultrasounds
and blood tests for cancer markers."
Women who know their cancer risk are also faced
with important decisions about preventive surgery.
"This is a very personal decision," says Dr. Cairoli.
"Some women choose to have breasts or ovaries
removed, while others choose to monitor their risk
with continued screenings."
Genetic testing helps families get answers
"After my sister and I were tested, I discussed the findings
with my other brothers and sisters, their children
and some other family members," says Devine. "I wanted
them to know about genetic testing, what the results
could tell them, and how it could save their lives," she
says. Seventeen of her relatives were tested; eight learned
that they carry mutations that could predispose them
to cancer. Now, they are able to make decisions about
preventing cancer.
For more information on FRAP or to attend a
family tree workshop, call 1-888-Virtua-3.
EXPERT PROFILES
Bridget LeGrazie, MSN, RN, AOCN,
APN, C, is an advancedoncology-
certified nurse.
She holds a master's degree
in nursing and an advanced
practice certification with
advanced education in
cancer genetics.
Maurice Cairoli, MD, completed his
undergraduate degree
with honors from the
University of Notre Dame.
He graduated from New
York Medical College in
New York and completed
a fellowship in hematology-
oncology at
Washington University of Medicine where he
also completed his residency. He is a boardcertified
medical oncologist.