Selected Podcast
Genetic Counseling: Know the Facts to Help Your Family
The Hereditary Cancer Program provides genetic counseling services to individuals and families who may be at high risk for a hereditary form of cancer.
Featuring:
Malavika Praseed, MS, CGC, LGC
Malavika Praseed Mcgrail, LCGC is a genetic counselor. She is a masters trained health care provider who collects and interprets genetic family histories; assesses the risk of disease occurrence or recurrence; identifies interventions to manage or ameliorate disease risk; educates about inheritance, testing, management, prevention, ethical issues, resources, and research; and counsels to promote informed choices and adaptation. Transcription:
Scott Webb (Host): The Hereditary Cancer Program at Franciscan Health provides genetic counseling services to individuals and families who may be at high risk for a hereditary form of cancer. Genetic counseling is typically recommended for people who have a personal and or family history, suggestive of a hereditary cancer condition. It's important to know, however, that having a family member with cancer does not automatically mean that you're in a high risk family. And I'm joined today by Malavika Praseed-McGrail. She's an Oncology and Prenatal Genetic Counselor with Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb.
So thank you so much for joining me. We're talking about the Hereditary Cancer Program at Franciscan Health, and I want to have you start by telling us about the testing that's done at Franciscan Health.
Malavika Praseed, MS, CGC, LGC (Guest): Here at Franciscan, our genetic testing programs are led by our team of genetic counselors, I, myself, am the Head of the Genetic Testing and Genetic Counseling Program for Northwest Indiana and south suburban Chicago. And we believe that patients understanding the implications of genetic testing and understanding what that means for themselves and their family, is paramount before embarking on that testing process.
So, whenever possible, we scheduled genetic counseling appointments to walk our patients through the ins and outs of testing. Cancer genetic testing has a variety of different purposes. Many of our patients have a personal or family history of cancer or both. And they're seeking to know if genetic testing could impact the kind of treatment they receive, the kind of management they should have and how their family members should be monitored and made aware.
And so there are a variety of purposes to genetic testing, and there are definitely pros and cons and having a cancer genetic counselor can definitely help patients understand these murky waters.
Host: Yeah, I'm sure there are pros and cons. And what can people expect when they meet with a genetic counselor?
Malavika: So, people often they come in and they don't know what to expect a lot of the time. I mean, most people have never encountered a genetic counselor. It's a fairly new field in the grand scheme of medicine, but generally what a patient can expect is a deep dive into someone's medical and family history. We spend a lot of time on the family history. Determining, you know, if there are malignancies in the family, how many family members, ages of onset. Gathering all of that information, as well as medical records information, we're able to make a risk assessment about, you know, the probability of testing positive, what a positive result could mean for a patient, understanding how genetic testing can affect things like insurance eligibility. And understanding the types of results that can come about with genetic testing. And so we normally take some time, usually 45 minutes to an hour to really explore all the information and explore a patient's concerns.
Host: And so I guess I'm wondering when should people consider being tested?
Malavika: That's a great question. Generally, in the cancer space, we think about it in regards to personal and family history and to get in a little more detail. There are a few factors that make us think, especially of hereditary cancer. The first thing I always tell my patients is most cancer is not hereditary. We estimate about five to 10% of cancer is hereditary, and that leaves a large percentage of cancers that are not hereditary and have other reasons for arising. And so those individuals who have been diagnosed at a younger age, typically 50 years old and younger, diagnosed with certain rarer cancers or have multiple family members diagnosed with cancer. There are a variety of different reasons someone can seek genetic counseling. And another thing I tell a lot of my patients is that meeting with a genetic counselor does not commit you to testing in any way. So, I have many patients who just want to know a little bit more about their history.
They don't know if they're at a particularly high risk and they're looking to someone to give them a little bit of guidance and find out if testing is right for them. And so I say, you know, genetic counseling is available to a lot of our patients, even if you don't think you meet these strict criteria. And I always advise talking to your physicians to see if a genetic counseling referral could be good for you.
Host: I'm sure that we all have that concern, that if we have a history of cancer or a particular cancer in our family, there's probably this feeling that people have, well then, you know, it's sort of an inevitability, you know, that it's going to continue on in a family and that everybody's at some higher risk because of that genetic connection to cancer. And that's just not the case, right?
Malavika: You're correct. So, that is a sort of a preconceived notion a lot of my patients have. They may think, okay, my mother and my grandmother had breast cancer. I know I'm going to develop breast cancer too. And you know, sometimes that fear, that trepidation can prevent patients from seeking genetic testing or seeking earlier screening.
But on another hand, we often think of this additional information as empowering in many ways, you know, even a negative result can be especially empowering. Obviously a negative testing result doesn't rule out the possibility of cancer. There are a variety of other factors that can predispose to cancer risk, but knowing the concrete information about genetic testing, it can really provide some tailored guidance. You know, how often should we receive this kind of screening? Who else in the family needs to be worried about screening. Information, can be really empowering and informing. And so that's something we usually tell our patients about, and there's always no obligation to have genetic testing.
Sometimes the counseling appointment alone can be informative and just having the opportunity to talk to a provider about your concerns and worries can be helpful in and of itself.
Host: Yeah, I think you're so right. Information and knowledge is power for sure. And so Malavika, what's involved in the testing?
Malavika: So, in the vast majority of our patients, genetic testing involves a blood or saliva sample. I get the question a lot of time, you know, is one more accurate than the other. And in many cases, both sample possibilities are usable. Saliva samples do allow for a little more flexibility. Blood samples are often sort of our first line, but either way, we are talking about a single tube of sample.
These often get sent out to a laboratory that specializes in genetic testing. We're often looking at multiple genes within a single sample, and then when results are reported out, whether they be positive results, negatives, or uncertain results; the genetic counselor, or other provider is able to communicate what those results are, coordinate follow up and talk about what's recommended as far as management.
Host: So, I want to have you tell us about the role that a oncology nurse navigators play. I know that they're really central and key in all of this, as are the genetic counselors. So, tell us about the oncology nurse navigators and the role that they play in genetic cancer testing.
Malavika: I really believe our oncology nurse navigators are indispensable to our overall cancer program. Having a single individual that you can trust and is great at communication and great at sort of aggregating all this clinical knowledge; having that point person is so essential, especially when you're new in your cancer treatment journey. And often the oncology nurse navigators, they're skilled in identifying patients benefit from a genetics referral, they're able to coordinate with physicians and often they're in close contact with me and our other genetic counselors to discuss whether or not testing or consult might be a good idea for the patient.
So in short, the oncology nurse navigator can be a really great point person for not only for genetic testing, but for all of the different scans, imaging, and tests that someone newly diagnosed with cancer might feel overwhelmed by. They're a great person to coordinate all of that.
Host: Yeah, you can see why somebody who's been diagnosed would feel a bit overwhelmed and great to know that the nurse navigators are there to help them through this process. And this been really educational today. As we wrap up, what are your takeaways on the Hereditary Cancer Program at Franciscan Health and anything else you'd like listeners to know?
Malavika: I think we are headed in a great direction here at Franciscan. Our genetics program continues to expand. We're continuing to sort of heighten our knowledge as to what's out there in terms of genetic testing. I always tell my patients, genetics is a constantly growing field. We're always learning about new genes and new variants that might contribute to overall cancer risk.
And so I usually tell the broader public, you know, don't be afraid to ask your physicians and ask your healthcare providers about genetic testing. If they are uncertain about ordering the testing themselves, they can certainly reach out to us over in the genetics department. This is what we do all day every day. And so we're happy to help out.
Host: Absolutely. Well, thank you so much for your time today. You stay well.
Malavika: Thank you so much.
Host: For more information, go to Franciscanhealth.org and search cancer genetic testing. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb (Host): The Hereditary Cancer Program at Franciscan Health provides genetic counseling services to individuals and families who may be at high risk for a hereditary form of cancer. Genetic counseling is typically recommended for people who have a personal and or family history, suggestive of a hereditary cancer condition. It's important to know, however, that having a family member with cancer does not automatically mean that you're in a high risk family. And I'm joined today by Malavika Praseed-McGrail. She's an Oncology and Prenatal Genetic Counselor with Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb.
So thank you so much for joining me. We're talking about the Hereditary Cancer Program at Franciscan Health, and I want to have you start by telling us about the testing that's done at Franciscan Health.
Malavika Praseed, MS, CGC, LGC (Guest): Here at Franciscan, our genetic testing programs are led by our team of genetic counselors, I, myself, am the Head of the Genetic Testing and Genetic Counseling Program for Northwest Indiana and south suburban Chicago. And we believe that patients understanding the implications of genetic testing and understanding what that means for themselves and their family, is paramount before embarking on that testing process.
So, whenever possible, we scheduled genetic counseling appointments to walk our patients through the ins and outs of testing. Cancer genetic testing has a variety of different purposes. Many of our patients have a personal or family history of cancer or both. And they're seeking to know if genetic testing could impact the kind of treatment they receive, the kind of management they should have and how their family members should be monitored and made aware.
And so there are a variety of purposes to genetic testing, and there are definitely pros and cons and having a cancer genetic counselor can definitely help patients understand these murky waters.
Host: Yeah, I'm sure there are pros and cons. And what can people expect when they meet with a genetic counselor?
Malavika: So, people often they come in and they don't know what to expect a lot of the time. I mean, most people have never encountered a genetic counselor. It's a fairly new field in the grand scheme of medicine, but generally what a patient can expect is a deep dive into someone's medical and family history. We spend a lot of time on the family history. Determining, you know, if there are malignancies in the family, how many family members, ages of onset. Gathering all of that information, as well as medical records information, we're able to make a risk assessment about, you know, the probability of testing positive, what a positive result could mean for a patient, understanding how genetic testing can affect things like insurance eligibility. And understanding the types of results that can come about with genetic testing. And so we normally take some time, usually 45 minutes to an hour to really explore all the information and explore a patient's concerns.
Host: And so I guess I'm wondering when should people consider being tested?
Malavika: That's a great question. Generally, in the cancer space, we think about it in regards to personal and family history and to get in a little more detail. There are a few factors that make us think, especially of hereditary cancer. The first thing I always tell my patients is most cancer is not hereditary. We estimate about five to 10% of cancer is hereditary, and that leaves a large percentage of cancers that are not hereditary and have other reasons for arising. And so those individuals who have been diagnosed at a younger age, typically 50 years old and younger, diagnosed with certain rarer cancers or have multiple family members diagnosed with cancer. There are a variety of different reasons someone can seek genetic counseling. And another thing I tell a lot of my patients is that meeting with a genetic counselor does not commit you to testing in any way. So, I have many patients who just want to know a little bit more about their history.
They don't know if they're at a particularly high risk and they're looking to someone to give them a little bit of guidance and find out if testing is right for them. And so I say, you know, genetic counseling is available to a lot of our patients, even if you don't think you meet these strict criteria. And I always advise talking to your physicians to see if a genetic counseling referral could be good for you.
Host: I'm sure that we all have that concern, that if we have a history of cancer or a particular cancer in our family, there's probably this feeling that people have, well then, you know, it's sort of an inevitability, you know, that it's going to continue on in a family and that everybody's at some higher risk because of that genetic connection to cancer. And that's just not the case, right?
Malavika: You're correct. So, that is a sort of a preconceived notion a lot of my patients have. They may think, okay, my mother and my grandmother had breast cancer. I know I'm going to develop breast cancer too. And you know, sometimes that fear, that trepidation can prevent patients from seeking genetic testing or seeking earlier screening.
But on another hand, we often think of this additional information as empowering in many ways, you know, even a negative result can be especially empowering. Obviously a negative testing result doesn't rule out the possibility of cancer. There are a variety of other factors that can predispose to cancer risk, but knowing the concrete information about genetic testing, it can really provide some tailored guidance. You know, how often should we receive this kind of screening? Who else in the family needs to be worried about screening. Information, can be really empowering and informing. And so that's something we usually tell our patients about, and there's always no obligation to have genetic testing.
Sometimes the counseling appointment alone can be informative and just having the opportunity to talk to a provider about your concerns and worries can be helpful in and of itself.
Host: Yeah, I think you're so right. Information and knowledge is power for sure. And so Malavika, what's involved in the testing?
Malavika: So, in the vast majority of our patients, genetic testing involves a blood or saliva sample. I get the question a lot of time, you know, is one more accurate than the other. And in many cases, both sample possibilities are usable. Saliva samples do allow for a little more flexibility. Blood samples are often sort of our first line, but either way, we are talking about a single tube of sample.
These often get sent out to a laboratory that specializes in genetic testing. We're often looking at multiple genes within a single sample, and then when results are reported out, whether they be positive results, negatives, or uncertain results; the genetic counselor, or other provider is able to communicate what those results are, coordinate follow up and talk about what's recommended as far as management.
Host: So, I want to have you tell us about the role that a oncology nurse navigators play. I know that they're really central and key in all of this, as are the genetic counselors. So, tell us about the oncology nurse navigators and the role that they play in genetic cancer testing.
Malavika: I really believe our oncology nurse navigators are indispensable to our overall cancer program. Having a single individual that you can trust and is great at communication and great at sort of aggregating all this clinical knowledge; having that point person is so essential, especially when you're new in your cancer treatment journey. And often the oncology nurse navigators, they're skilled in identifying patients benefit from a genetics referral, they're able to coordinate with physicians and often they're in close contact with me and our other genetic counselors to discuss whether or not testing or consult might be a good idea for the patient.
So in short, the oncology nurse navigator can be a really great point person for not only for genetic testing, but for all of the different scans, imaging, and tests that someone newly diagnosed with cancer might feel overwhelmed by. They're a great person to coordinate all of that.
Host: Yeah, you can see why somebody who's been diagnosed would feel a bit overwhelmed and great to know that the nurse navigators are there to help them through this process. And this been really educational today. As we wrap up, what are your takeaways on the Hereditary Cancer Program at Franciscan Health and anything else you'd like listeners to know?
Malavika: I think we are headed in a great direction here at Franciscan. Our genetics program continues to expand. We're continuing to sort of heighten our knowledge as to what's out there in terms of genetic testing. I always tell my patients, genetics is a constantly growing field. We're always learning about new genes and new variants that might contribute to overall cancer risk.
And so I usually tell the broader public, you know, don't be afraid to ask your physicians and ask your healthcare providers about genetic testing. If they are uncertain about ordering the testing themselves, they can certainly reach out to us over in the genetics department. This is what we do all day every day. And so we're happy to help out.
Host: Absolutely. Well, thank you so much for your time today. You stay well.
Malavika: Thank you so much.
Host: For more information, go to Franciscanhealth.org and search cancer genetic testing. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.