Maggie McKay (Host): When someone in your family has cancer, it's natural to wonder what role genetics and cancer risk play. So today we'll find out with Alyssa Valentine and Erika Radeke.

 Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today we're going to talk with Cancer Genetic Counselor, Alyssa Valentine, and Director of Operations at the Cancer Center, Erika Radeke about how genetics and family history affects your cancer risks. So let's just start with some basic background on genetics, Alyssa. Can you get into a little bit of how genes relate to cancer?

Alyssa Valentine, MS, LCGC: Absolutely. First, just as a background with genes, so we're all on the same page as we get going here, our genes really are the instructions that tell our body how to make everything that it needs to make. And some of our genes have instructions that help protect our body from getting cancer.

So when we say somebody's cancer is hereditary or has a genetic cause, what we mean by that is that they were born with a change in one of these cancer genes that put them at a higher risk to develop cancer. And so this is only applicable for about maybe 5 to 15 percent of people with cancer, when I say it's hereditary, I mean.

Host: And what is genetic testing?

Alyssa Valentine, MS, LCGC: So genetic testing is typically done with a blood sample or sometimes a saliva sample or a cheek swab. And when we do collect this sample, we send it off to a lab and it looks through your cancer genes to see if you were born with any of those changes that I was talking about that would mean that your cancer is hereditary.

Host: What else can genetic testing tell you?

Alyssa Valentine, MS, LCGC: So genetic testing, really, it helps us personalize how we take care of you and provides your providers and doctors with the most accurate risk assessment for what are your chances for developing cancer. That really depends on what the results are from the genetic testing and also what your family history of cancer is.

Host: Will genetic testing tell me if I have cancer for sure?

Alyssa Valentine, MS, LCGC: Genetic testing cannot tell you if you have cancer at that moment. What genetic testing would tell you is if you were born at a higher risk to develop cancer or not.

Host: So, if genetic testing is negative, will I never get cancer?

Alyssa Valentine, MS, LCGC: It's a great question, and I wish that was true. I wish if your test was negative that you would never get cancer, but unfortunately, you know, we all have a risk to develop cancer, because there's a lot of different risk factors for developing cancer that we're all faced with. Just getting older, lifestyle factors, environmental factors. Those all still play a role, even if somebody's genetic testing doesn't show that they were born at a higher risk to get cancer.

Host: And could you please give an example or so of how just the family history might change the approach for an individual patient in how they're screened or managed?

Alyssa Valentine, MS, LCGC: Yeah, absolutely. So, let me talk a little bit about when somebody's test results, genetic testing results are negative, because that's when their family history really plays a more significant role in what my recommendations would be for them. So if somebody's test results don't show that they have a genetic risk for getting cancer, their family history then becomes the most accurate information that I have to try to personalize what I recommend for their cancer screening.

So, for example, if somebody has a lot of women in their family have breast cancer, and many women have gotten breast cancer before the age of 50, so a young diagnosis; that information, even if their results are negative, could still be enough for them to be eligible to do additional breast cancer screening, like doing a breast MRI as well as a breast mammogram, even starting at a little bit of a younger age too, just based on their family history, even if their results are negative.

Host: And you kind of touched on this a little bit, but who specifically needs genetic testing for sure?

Alyssa Valentine, MS, LCGC: That's a great question. I think a lot more people need it than maybe they realize. I think especially because a lot of the information that we use as genetic counselors to determine who should get genetic testing relies on somebody's family history of cancer. I think when it comes to personally, if you have cancer, your doctors are telling you that it's a rare type of cancer, or there's a handful of certain types, which we can talk a little bit more about in a second, that if you have that history yourself, that would be a reason to do genetic testing, just based on your own history.

And then a lot of our determination about who needs testing also depends, like I said, on your family history. So if you have a strong family history of cancer, if there's a lot of people who get cancer really young, before the age of 50, if people have had multiple cancers in their lifetime, or if there's a lot of people with the same type of cancer especially; those are all kind of red flags, we call them, that tell me as a genetic counselor, okay, there might be a genetic explanation here and this person should get some genetic testing.

Host: And are there certain cancers that are more strongly associated with some sort of inherited connection?

Alyssa Valentine, MS, LCGC: Yes, absolutely. There are some cancers that are not related to genetics or hereditary risks at all, like cervical cancer, for example. And when it comes to cancers that are connected, strongly connected with genetics, the few off the top of my head that I would always want to order genetic testing for somebody with, would be if somebody has pancreatic cancer, ovarian cancer. If they have metastatic prostate cancer or an aggressive type of prostate cancer that spreads throughout their body. Everybody with those types of cancers should get some genetic testing. For other types of cancers, it depends a little bit more on how old you were when you were diagnosed and then again that family history if there's other people with the same type of cancer or things like that.

So for like breast cancer, colon cancer, uterine cancer, stomach cancer, those types of cancers, again, if you're before the age of 50, then that's when I would really want to make sure we're doing that genetic testing for you.

Host: Why is it important for people to know their family history and what do they need to know?

Alyssa Valentine, MS, LCGC: Yes. So this is one of my major things I wanted to talk about here. I think from my standpoint as a genetic counselor, one of the biggest pieces of information that I use, like I said, to decide if genetic testing is going to be beneficial for you, is based on your family history of cancer.

So I think it's really important and I really encourage everybody to try to have those conversations with their family and ask questions like, who had cancer in the family, what is my relation to them, like how closely related to you, what type of relationship that is, and then what types of cancer they had, how old they were when they had that cancer.

All of that type of information is really important for us as your providers who take care of you to figure out if genetic testing would be helpful for you. So, if you get that information, my suggestion would be write that information down so you don't have to remember it, and then bring that written information into your next doctor's appointment.

Host: And is the genetic testing approach any different if you're a patient with cancer? Is it going to change how you manage the current cancer?

Alyssa Valentine, MS, LCGC: So, the approach that we take to genetic testing and like the genetic test itself wouldn't be any different for somebody who has cancer versus somebody who does not have cancer at that moment. It's more so how we use that information that may be a little bit different, on the back end, if you have cancer or not.

So for somebody who has cancer, if their test results are positive or show that they have that genetic hereditary explanation, then that information might be used to help tailor their treatment plan. So maybe a different surgery or a different medication is going to be better for you, based on the genetic testing results.

But for somebody who doesn't have cancer at the moment, if their results are positive and again, show that hereditary risk or higher risk for getting cancer based on that test result; then we would be focused more on what can we do to prevent you from getting cancer or what kind of increased screening plan can we recommend to catch that cancer as early as possible, because cancers are much easier to treat and have better outcomes when we find them as early as possible.

Host: And how is genetic testing done? Is it affordable?

Alyssa Valentine, MS, LCGC: Yeah, so I love talking about this. Genetic testing has gotten so much more affordable in the last 20 years than it was. You know, in the past it used to be quite expensive, but now, almost every insurance company is going to cover genetic testing for you. If you don't have insurance, there's still a lot of options especially at Cook County, we can really help you figure out how to get access to genetic testing at a very affordable cost. I will say most of our patients that I see, they don't pay anything out of pocket for genetic testing actually.

Host: Wow, that's impressive. What is genetic counseling? What happens during a genetic counseling appointment and how can I meet with a genetic counselor?

Alyssa Valentine, MS, LCGC: Absolutely. So genetic counselors, we're licensed healthcare providers who went through training and have a lot of expertise in genetic testing and how to talk about your family history to determine, again, how worried are we that there could be this hereditary explanation for whatever is going on in your family.

So that's our background. And when it comes to how do you talk to us and what to expect for the appointment; during a genetic counseling appointment, it's really going to be a lot of talking. We're have a lot of kind of conversation back and forth at the end of the day. So, first, what do we talk about of course? We talk a lot about your personal history. We're going to go through a very detailed family history, going through asking you all those questions that I said to ask your family about who's had cancer, how old, all of that type of information. And then from there, we'll talk about what is genetic testing? We'll talk to you about what are the possible results from the testing. So that way, at the end of the appointment, you're able to make the best decision for yourself. Is genetic testing something you're interested in or is it maybe not right for you at the moment? Genetic testing, it's not something that you're ever going to be forced to do or like mandatory in any way.

It's going to be something that you get to decide at the end of our appointment and our discussion if it's right for you. So like I said, mostly it's going to be a conversation. If you decide you want the genetic testing, then we'll get that blood draw that I talked about earlier to do that, to actually do the genetic test.

And then we'll see you on the backend when we get those results to go through everything, all the next steps, what the results showed and all of that information. If you would like to meet with us at Cook County Health, at least, you can just ask your doctor to place a referral to see us. They can do it right in your medical chart, and just put in that referral to the cancer genetics clinic, and then we'll schedule an appointment and meet with you.

Host: It sounds very thorough and like you have all the bases covered, so that's encouraging. Erika, can you tell me about Cook County's new Cancer Center?

Erika Radeke, MS: Sure. Thank you, Maggie. And thank you, Alyssa. We've been providing cancer care at County for decades, of course. But in the last several years, we've developed more into an official cancer center. We wanted to take a look at what we've already been providing and add really comprehensive care across the entire continuum, from prevention all the way to survivorship. So we looked at all of the areas that we've needed to add and supplement to make a patient's experience that more successful. And so we've added services like genetic counseling, of course, survivorship, where patient has finished their acute treatment, and moved on to just kind of surveillance, right?

 We have patient navigation to get patients from A to B, make sure there's nothing confusing about their care. We have mental health support for our patients, social services support. So really proud of the work that we've been providing, and of course, you know, like Alyssa suggested and outlined for us today, genetic counseling is a very important part of that process and a piece of cancer prevention and then if you do have cancer, understanding what the history is there. We've been accredited by the Commission on Cancer for 25 years and we're very proud of that. And we're continuing to grow and provide provide great services for patients who come to Cook County Health.

Host: That's awesome. Alyssa, what's the key takeaway in closing, that people need to know and keep in mind as they think about this issue in their own health and that of their family?

Alyssa Valentine, MS, LCGC: My first thing that I would recommend and want people to take away from listening in today is talk to your family, ask these questions, ask them who's had cancer and what type and all of that information and bring it to your doctors. I also would encourage people, I know some, cancer especially can be a very private thing in families. Some families don't like to talk about it. So I would say, you know, if that's your family situation, I would encourage you to explain why you're asking these questions. You're not being nosy. You're really asking information that can be really impactful for your care, taking better care of yourself, like I said, catching cancers earlier, preventing them.

So that's I think one of the first things to take away from this conversation. And then the second thing is if you find out after you ask these questions that genetic testing and counseling is something that would be beneficial for you, ask your doctors to put in that referral because genetic testing and counseling can really help your providers take better care of you and also your family members.

Genetic testing, when I see patients, it's about them, of course, the person sitting in front of me, but it's also about all of their family members because it has an impact on their family, you know, families share DNA. And so it can really go beyond just you and can impact your family members to help provide better cancer screening and surveillance, based on that information.

Host: Well, this has been so informative. Thank you both so much for sharing your expertise. We appreciate it.

Erika Radeke, MS: Thank you, Maggie.

Alyssa Valentine, MS, LCGC: Thank you for having us.

Host: Again, that's Alyssa Valentine and Erika Radeke. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast, and subscribe to our podcast, share, and connect with us on social media.

Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.