Scott Webb (Host): Today, we're going to learn about the exciting advances and advantages in genetic testing at the Health First Cancer Institute from Delori Dulany, she's a genetic navigator with Health First.

 This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. Delori, it's so nice to have you here today. I've been excited about this conversation. I want to learn more about genetic testing. And so, it's great to have you here, have your expertise. Let's start there. What is genetic testing?

Delori Dulany: Genetic testing is a blood test that we can do to see if you have a predisposition or an increased risk for certain kind of cancers.

Host: Yeah, that's kind of what I thought it was, and I was like maybe I'm overcomplicating this in my head, but I guess it makes me wonder, like, what are some of the benefits, right? You make it sound so easy and it does sound relatively easy. Of course, maybe once we get insurance involved, it's not quite so easy. But for our purposes on the medical side of things, what are the benefits of genetic testing?

Delori Dulany: The benefits of genetic testing can be all the way from self-knowledge about what your health may be in the future, as well as to treatment guidelines for patients who currently are dealing with cancer. So, if I know that you have a genetic mutation, we know that we need to do things differently for your care today. So in that way, you can own your health in the future.

Host: I like that. It's sort of like looking into a crystal ball a little bit. You know, I've often said on different podcasts that I've done, you know, well, you can't outrun your family history and your genetics, but here you really can get in touch with and connect with your family history and genetics as predictors perhaps of certain cancers. And I guess it makes me wonder, are there different types of testing?

Delori Dulany: There is different types of testing. The testing that I do here at the Health First Cancer Institute is I do germline testing. So, germline testing is looking at all your germline cells, your gene cells to see if you carry a gene that is mutated and that's when it doesn't behave or perform the way that it's supposed to.

There is other testing that we can do, which is also considered genetic testing, such as if there's a cancer tumor, we can look at that particular tumor and see what genes it has, which can help us determine what treatment protocol would be appropriate for that patient. So, that's another way to look at genetic testing, which isn't germline looking at your risk. It is actually hands-on treatment protocols.

Host: Yeah. It's really amazing. It sounds a little like science fiction, but it's real. It's happening. You do it so you would know, right? Is anybody eligible or is everybody eligible for genetic testing?

Delori Dulany: That's a two-edged question there. I am a firm believer in genetic testing. I think everybody should test, because it gives you, like I said, ownership of your health in the future. Insurance doesn't always agree with me on that. So, we do look at family history and then go from there.

Host: Yeah. And it does seem that that thread here is the family history part of it. So, just making sure I understand this, I'm assuming then folks with a strong family history of certain types of cancers or many types of cancer, they would be more inclined to want to do this. Insurance would be more inclined to want to pay for it. Are those all sort of factored into the decision to get tested?

Delori Dulany: Absolutely. Absolutely. And on the flip side of that, patients who don't have a family history, so patients who were like adopted and there is no known history because you know that communication was cut, they're excellent candidates because we don't know what's in their family.

Host: Right. Have no idea, of course. Interesting. I hadn't thought of that. But that's why we have the experts of course. So, you make it sound so simple. So, can I assume that it's just a simple blood test in the office, that kind of thing? Or is there more involved in the testing process?

Delori Dulany: So for the patients, I hate to call them patients because they're not really patients. But the people that I see and come to see me, they come in the office and we talk about the pros and cons and the what ifs of positive or pathogenic results, and then we talk about what they would like to look into. Sometimes patients are concerned about their privacy, but this is considered medical grade testing. So, it stays in your medical chart just like everything else. So, that's not being sold on the internet to the highest bidder.

Host: Sure.

Delori Dulany: Once the decision is made to proceed with genetic testing, we can look at a certain set of genes like breast cancer genes, or we can look at colon cancer genes, or we can combine the two and look at all the genes. And there is a saliva kit that can be done or a blood test. They tell me that the saliva kit is as accurate as the blood test, but I have a higher failure rate. It doesn't pass quality assurance when it gets to the lab. And so then, the patient has to come back. So, I prefer just to draw the blood and have it be a one-and-done type thing.

Host: Yeah. One and done, for sure. So, let's talk then about the results. How quickly do folks find out if they're positive or negative? If that's the right way to say that.

Delori Dulany: That is. Usually, the results can take from two and a half to about four weeks. The average is about three weeks.

Host: Still pretty good, all things considered, and especially the type of information, the important information to get from, as you say, the blood test or the saliva. So, what does it mean then if the results for your test are positive?

Delori Dulany: So, a positive test or a pathogenic test simply means that you have a gene, and we're only looking at cancer genes. There's thousands of other genes that I don't look at. We're only looking at the cancer genes. So, you have a cancer gene that is mutated or not functioning appropriately, so that can increase the risk for cancer. It is not a guarantee that you're going to get cancer, nor is it that we're looking for cancer. We're looking at risk assessment.

Host: Yeah, I was going to ask you about that. So, right, in other words, if the test results are positive, then, you know, do you have any statistics or just to give us a sense, like how often does that lead to cancer in folks or is that still a bit of a work in progress?

Delori Dulany: We have some pretty good numbers. They do change with research. So, the most famous gene in the world, of course, is the BRCA gene, the breast cancer gene. So for the breast cancer one gene, the risk for breast cancer alone is between like 55% and 70%. So, they're expecting approximately 70% of those BRCA carriers to wind up with cancer.

Host: Interesting.

Delori Dulany: We can't change the gene, but we change the care that we give, and that is where we step in with medications that can reduce the risk, or surgical procedures that can reduce the risk and/or high risk screening.

Host: Right. Yeah. And earlier diagnosis leads to earlier treatment, and that leads to better outcomes, right?

Delori Dulany: Absolutely. The earlier we can find something, the better the outcomes are.

Host: Yeah. So then, what are the next steps for folks, right? As you say, we don't necessarily call them patients, but folks in general, people in general who have this testing done, what are the next steps?

Delori Dulany: So here at the Health First Cancer Institute, I allow patients to self refer in. So, they can self refer in. They meet with me, we talk about it, they make their decision, we test, and then I see them back in three weeks. Other times, patients are already connected with their primary cares or their other specialty physicians, you know, like the breast surgeons or the GYN physicians or things like that, and they will refer them over to me. And it's, you know, the same kind of process. We talk about the pros and cons. I answer all the questions, and then we proceed with testing.

Host: Yeah. I just want to finish up here, and we're just, I know, scratching the surface of an incredibly exciting and complex topic, but are there ways that folks can prevent or reduce the chance of cancer if they test positive?

Delori Dulany: Absolutely. Absolutely. Of course, we all know to exercise, eat healthy, normalize your weight. All those are increased factors for cancer. Avoidance of smoking, you know, limited alcohol intake, all of those things, which we all know, but we still need to hear them again because we're humans.

Host: Of course. Yeah.

Delori Dulany: All of that can help reduce the cancer risk. And like with the breast cancer risk, we talk about, you know, if you have the BRCA1 gene, we can talk about removing the breast and that therefore decreases that risk by about 90%. So, if you don't have any breast tissue, it's much harder to get breast cancer. So, you know, but we of course would only do that in a patient who is past childbearing. We're not going to talk those kind of options on a woman who has not passed childbearing.

Host: Right.

Delori Dulany: Because I've had some young ones be concerned that, you know, they don't want to lose their breast at 25. Well, of course not. Nobody's going to suggest that. Come back when you're 45

Host: Right, yeah. And I really like hearing that it's not one-size-fits-all when it comes to the testing and the next steps and all of that, that it's very individualized to the patient and where they are in life and what their goals are and needs and all of that, right?

Delori Dulany: Oh, absolutely, absolutely. I have some women, and I focus on the BRCA gene mainly because that's the gene everybody knows. But I have some women who tell me that, you know, "These are my breast and they were placed there and I'm not getting rid of them." Okay, we respect that decision and we put you in high risk screening. That way, we're looking at your breast every six months, and they don't have to feel uncomfortable with their decision. That is a perfectly appropriate decision if that's where they live in their lives. You know, other patients come in and they're like, "These got to go. I I can't live with that stress." That's okay too. You know, we support whatever the patient, wherever they are in their journey.

Host: Right. Yeah, that's such a good way to put that and a good way to finish. As I said, I feel like we're just scratching the surface here today. But hopefully, it did that for folks, lets them know more about genetic testing and what options are available through Health First. And that somewhere during this process, in this journey, they may end up speaking with you, and they're going to receive the best consultation, the best care, all of that. So, thank you so much.

Delori Dulany: Yes, sir.

Host: The Cancer Institute provides support groups to set up connections with others experiencing similar situations in a safe and compassionate space. You'll find a supportive community where feelings can be shared for encouragement, hope, and ideas for coping with cancer. Support groups are open to patients and caregivers with the goal of having independent groups for each at a later date. For questions about a support group, call 321-728-6002. And if you'd like to learn more about genetic testing at Health First, please visit hf.org and search Cancer Genetic Testing.

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