Have any of your close relatives had cancer?
Researchers know that cancer can “run in families” and can have a genetic component.
Increasingly people who feel they have a high cancer risk, especially for breast and ovarian cancer, are getting genetic testing, but this can be stressful and bring up difficult decisions and emotional issues.
To learn more about genetic screenings for cancer, tune into SMG radio for an interview with SMG;s genetic counseling expert, Niecee Singer Schonberger.
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Genetic Testing for Cancer
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Learn more about Niecee Singer Schonberger
Niecee Singer Schonberger, MS, GCC
Trained in the fields of psychology and genetics, Niecee Singer Schonberger is a genetic counsellor at Summit Medical Group. She addresses the personal and emotional issues associated with genetic counseling.Learn more about Niecee Singer Schonberger
Transcription:
Genetic Testing for Cancer
Melanie Cole (Host): Have any of your close relatives had cancer? Researchers know that cancer can run in families and can have a genetic component. Increasingly, people who feel they have a high cancer risk, especially for breast and ovarian cancer, are getting genetic testing but this can be stressful and bring up difficult decisions and emotional issues. My guest today is Niecee Singer Shonberger. She’s a genetic counselor at Summit Medical Group. Welcome to the show, Niecee. So, tell us who is a genetic counselor? What do you do?
Niecee Singer Shonberger (Guest): A genetic counselor is a board certified Master of Science degree individual who meets with individuals who are concerned about the cancer in their family. What we do is sit down with the individual and the most important part of genetic counseling is the family history because that gives us a clue as to whether the cancer in the family is genetic or it’s not genetic. It’s important to understand that 90-95% of cancers are not genetic, so we need to identify the 5-10% of families that may be genetic so we can then discuss the genetic testing that’s available.
Melanie: Explain a little bit about genetics itself, Niecee, and give us a little physiology of genetics.
Niecee: The terms “gene” and “mutation” are sometimes used interchangeably but they mean different things. A gene is a sequence of DNA and the genes we test for are genes that everybody has. A mutation, on the other hand, is a change in the gene that’s associated with an increased risk of cancer and this is what the testing is designed to identify.
Melanie: If people don’t have a family history of cancer but they still get cancer, is it safe to say that genetics isn’t playing a role in their cancer? And, if somebody doesn’t have a history of cancer in their family should they still consider genetic testing?
Niecee: That’s a good question. One of the criteria for genetic testing is Ashkenazi Jewish ancestry. So, if the individual is the only one in her family with the cancer, she would be eligible for the testing. Other than that, because of the fact that 90-95% are not genetic, if there’s just one individual in the family genetic testing is probably not suggested.
Melanie: So, how do you make that decision whether to get a genetic test or not?
Niecee: It’s the family history. The features of the family history that are indicative of genetic predisposition are early onset diagnosis of the cancer, multiple members in the family with the same or related cancers on the same side of the family, male breast cancer could be a feature that could suggest genetic predisposition and, certainly, if there’s a known mutation in the family already. Those would be the individuals who would probably be suggestive of a genetic predisposition.
Melanie: What’s involved in the testing process, Niecee?
Niecee: Well, when I meet with somebody, I meet with them for approximately an hour. Half of the time, we talk about the family history. The other half of the time, we talk about the testing options. The testing options have expanded greatly over the last couple of years. Up until the last couple of years, the only testing options were the two BRCA genes that most people know about, the BRCA gene. Now, we have many, many genes-- multiple genes--that are available in a panel of, say, 13, 25, 32 or more genes that can be test for their “associated with” inherited cancers. So, we talk about the options of the various panels – what would be the most appropriate panel for the patient. We talk about the benefits of the testing for herself--and I’m saying herself because usually it’s a women. It could be a man. The benefits for herself and for her family and also the limitations of the testing because it’s new technology. We still don’t know everything that there is to know.
Melanie: What do you do with the results and how do you know who to go to next if those results do come out positive?
Niecee: One thing, when we are talking about the results, I would like to step back a minute and say that the most informative person to test in the family is somebody who has already had the cancer. That may not be the person who comes to the genetic counseling. A negative result in an unaffected person is uninformative unless there’s been a mutation identified in the family already. With regard to what to do with the results, it depends on whether the individual is affected or unaffected but then we would talk about the level of risk associated with the particular gene. Some genes are associated with breast and ovarian cancer, some with colon cancer, some with pancreatic cancer, so depending upon what gene mutation has been identified in the family, we would talk about management options and which doctors would be appropriate for the patient to be surveyed over her lifetime. Also, the other part of the result is the family because if the individual is found to have a mutation in a gene, then her or his children each have a 50/50 chance of also having that mutation and that’s true of other family members.
Melanie: What about the insurance situation? I would imagine that some people are afraid to get a genetic test for life insurance purposes and/or health insurance purposes. So, where does that fit into the picture, Niecee?
Niecee: Those are two different situations. With regard to health insurance, there is a genetic information non-discrimination act called GINA which is a Federal law that prohibits discrimination by health insurance companies based on genetic information and testing. So, that’s not a problem.
Melanie: Wow. That is a good answer so beautifully put. Now, in just the last few minutes what are the most important bits of information that you would like people to understand about genetic counseling and how it can help families?
Niecee: Many families have a family member who knows everything about everyone in the family – an aunt, a grandparent, a cousin, perhaps – if you could spend time with him or her and learn the details about the specific cancers in the family and the ages of diagnosis, then the genetic counseling session and the risk assessment based on the family history will be very definitive and informative and helpful. I think that’s the go ahead message for everybody to learn about their family history.
Melanie: Niecee, tell us about Summit Medical Group and the genetic counseling there.
Niecee: Well, we obviously have genetic counseling available. We do have a multi-discipline team at Summit Medical Group so that anything that comes up during the genetic counseling and is a result of the testing we have the doctors right on hand who can deal with whatever the issues are that are presented by the results of the genetic testing.
Melanie: Thank you for such great information and so well spoken. Thank you for being with us today. You’re listening to SMG Radio and form more information you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Genetic Testing for Cancer
Melanie Cole (Host): Have any of your close relatives had cancer? Researchers know that cancer can run in families and can have a genetic component. Increasingly, people who feel they have a high cancer risk, especially for breast and ovarian cancer, are getting genetic testing but this can be stressful and bring up difficult decisions and emotional issues. My guest today is Niecee Singer Shonberger. She’s a genetic counselor at Summit Medical Group. Welcome to the show, Niecee. So, tell us who is a genetic counselor? What do you do?
Niecee Singer Shonberger (Guest): A genetic counselor is a board certified Master of Science degree individual who meets with individuals who are concerned about the cancer in their family. What we do is sit down with the individual and the most important part of genetic counseling is the family history because that gives us a clue as to whether the cancer in the family is genetic or it’s not genetic. It’s important to understand that 90-95% of cancers are not genetic, so we need to identify the 5-10% of families that may be genetic so we can then discuss the genetic testing that’s available.
Melanie: Explain a little bit about genetics itself, Niecee, and give us a little physiology of genetics.
Niecee: The terms “gene” and “mutation” are sometimes used interchangeably but they mean different things. A gene is a sequence of DNA and the genes we test for are genes that everybody has. A mutation, on the other hand, is a change in the gene that’s associated with an increased risk of cancer and this is what the testing is designed to identify.
Melanie: If people don’t have a family history of cancer but they still get cancer, is it safe to say that genetics isn’t playing a role in their cancer? And, if somebody doesn’t have a history of cancer in their family should they still consider genetic testing?
Niecee: That’s a good question. One of the criteria for genetic testing is Ashkenazi Jewish ancestry. So, if the individual is the only one in her family with the cancer, she would be eligible for the testing. Other than that, because of the fact that 90-95% are not genetic, if there’s just one individual in the family genetic testing is probably not suggested.
Melanie: So, how do you make that decision whether to get a genetic test or not?
Niecee: It’s the family history. The features of the family history that are indicative of genetic predisposition are early onset diagnosis of the cancer, multiple members in the family with the same or related cancers on the same side of the family, male breast cancer could be a feature that could suggest genetic predisposition and, certainly, if there’s a known mutation in the family already. Those would be the individuals who would probably be suggestive of a genetic predisposition.
Melanie: What’s involved in the testing process, Niecee?
Niecee: Well, when I meet with somebody, I meet with them for approximately an hour. Half of the time, we talk about the family history. The other half of the time, we talk about the testing options. The testing options have expanded greatly over the last couple of years. Up until the last couple of years, the only testing options were the two BRCA genes that most people know about, the BRCA gene. Now, we have many, many genes-- multiple genes--that are available in a panel of, say, 13, 25, 32 or more genes that can be test for their “associated with” inherited cancers. So, we talk about the options of the various panels – what would be the most appropriate panel for the patient. We talk about the benefits of the testing for herself--and I’m saying herself because usually it’s a women. It could be a man. The benefits for herself and for her family and also the limitations of the testing because it’s new technology. We still don’t know everything that there is to know.
Melanie: What do you do with the results and how do you know who to go to next if those results do come out positive?
Niecee: One thing, when we are talking about the results, I would like to step back a minute and say that the most informative person to test in the family is somebody who has already had the cancer. That may not be the person who comes to the genetic counseling. A negative result in an unaffected person is uninformative unless there’s been a mutation identified in the family already. With regard to what to do with the results, it depends on whether the individual is affected or unaffected but then we would talk about the level of risk associated with the particular gene. Some genes are associated with breast and ovarian cancer, some with colon cancer, some with pancreatic cancer, so depending upon what gene mutation has been identified in the family, we would talk about management options and which doctors would be appropriate for the patient to be surveyed over her lifetime. Also, the other part of the result is the family because if the individual is found to have a mutation in a gene, then her or his children each have a 50/50 chance of also having that mutation and that’s true of other family members.
Melanie: What about the insurance situation? I would imagine that some people are afraid to get a genetic test for life insurance purposes and/or health insurance purposes. So, where does that fit into the picture, Niecee?
Niecee: Those are two different situations. With regard to health insurance, there is a genetic information non-discrimination act called GINA which is a Federal law that prohibits discrimination by health insurance companies based on genetic information and testing. So, that’s not a problem.
Melanie: Wow. That is a good answer so beautifully put. Now, in just the last few minutes what are the most important bits of information that you would like people to understand about genetic counseling and how it can help families?
Niecee: Many families have a family member who knows everything about everyone in the family – an aunt, a grandparent, a cousin, perhaps – if you could spend time with him or her and learn the details about the specific cancers in the family and the ages of diagnosis, then the genetic counseling session and the risk assessment based on the family history will be very definitive and informative and helpful. I think that’s the go ahead message for everybody to learn about their family history.
Melanie: Niecee, tell us about Summit Medical Group and the genetic counseling there.
Niecee: Well, we obviously have genetic counseling available. We do have a multi-discipline team at Summit Medical Group so that anything that comes up during the genetic counseling and is a result of the testing we have the doctors right on hand who can deal with whatever the issues are that are presented by the results of the genetic testing.
Melanie: Thank you for such great information and so well spoken. Thank you for being with us today. You’re listening to SMG Radio and form more information you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.