What is genetic counseling and is it necessary for every woman?
Licensed and board-certified genetic counselor, Nadine Rayes, MS, provides cancer risk assessments based on medical and family history, genetic testing options and recommendations for preventive screening and surgical interventions.
Nadine shares what genetic counseling is, who it is appropriate for and how it could benefit your health to know if you carry hereditary genes for breast or ovarian cancer.
Selected Podcast
What to Know about Genetic Counseling
Featured Speaker:
Organization: Orange Coast Memorial Medical Center
Nadine Rayes, MS, LCGC
Nadine Rayes is a licensed and board-certified genetic counselor. She completed her bachelor's degree in Biological Science at the University of California, Irvine and received her Masters of Science in Human Genetics and Genetic Counseling from Stanford University. She provides cancer genetic counseling at both Saddleback Memorial and Orange Coast Memorial Medical Centers within the Cancer Risk and Prevention program. Her role involves providing cancer risk assessments based on medical and family history, discussing genetic testing options and providing recommendations for preventive screening and surgical interventions.Organization: Orange Coast Memorial Medical Center
Transcription:
What to Know about Genetic Counseling
Deborah Howell (Host): Hello. Welcome to the show. You are listening to Weekly Dose of Wellness. It’s brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Nadine Rayes, a licensed and board-certified genetic counselor. She completed her Bachelor’s Degree in Biological Science at the University of California, Irvine and received her Master’s of Science in Human Genetics and Genetic Counseling from Stanford University. Nadine provides cancer genetic counseling at both Saddleback Memorial and Orange Coast Memorial Medical Centers within the Cancer Risk and Prevention Program. Her role involves providing cancer risk assessments based on medical and family history, discussing genetic testing options, and providing recommendations for preventive screening and surgical interventions. It’s a lot to say and it’s a lot to do. Welcome to you, Nadine. Nadine Rayes (Guest): Thank you so much for having me. Deborah: Today’s show is called “What to Know about Genetic Counseling.” There is so much to know, so first of all, what is genetic counseling, and what does a Genetic Counselor do for patients? Rayes: Genetic counseling is a consultation, essentially. What I do with patients is sit down and really provide a risk assessment by gathering personal family history information about an individual and seeing how likely it is that they have some hereditary cancers undermining in their family. Aside from that, if there isn’t one, how likely is it that they’ll develop cancer. By doing that, our goal is really to individualize a screening plan for them. Deborah: Can we jump right to Angelina Jolie? Can we just do that? Because it’s the elephant in the room, right? Tell us a bit about your take on what she did. You’re in the field. What would you say? Rayes: I think the story of Angelina Jolie is great because it’s gotten everybody talking about these cancer genes and about talking to each other within a family who has cancer and is it running in our family. Angelina Jolie tested positive for BRCA1, one of the most common hereditary cancer syndrome genes for breast cancer. Since she tested positive without having any cancer, she went ahead and had a preventative mastectomy to reduce that risk of breast cancer and essentially eliminate it. That choice is not for everyone, but it is the choice of many women who do test positive. Part of our role as genetic counselors is to sit down with those women and say how likely is it that this is in your family. If it is running there, what is the right choice for you? Maybe the same decision that she made, maybe something very different. Deborah: What can a woman expect in going in for genetic counseling, and about how long does it take? Rayes: It’s basically an office visit, sit down. And a good portion of the visit will be collecting that personal family history information. We try to have people do their homework before coming in and make those phone calls that they need to gather that information. Part of that is also educating and letting patients know what we are looking for, why we’re looking for it, and what the results may mean. That can lead us down the path to genetic testing, which we can do at that visit, or it may not lead us down that path. It may lead to, again, making those screening recommendations for the patient. Deborah: What’s the most common gene mutation that causes cancer? Rayes: Gene mutations are pretty rare in cancer-causing syndrome. They cause about 5 to 10 percent of cancers. It’s very small. We have a low threshold for investigating them because we know there’s so much we can do to be proactive and preventative. The most common genetic mutations that cause hereditary breast cancer are those BRCA1 and BRCA2 genes. It’s the one that are in the news right now because of Angelina Jolie. Deborah: Is that a simple blood test? How does that happen? Rayes: It’s a simple blood test. It could also be a saliva sample. Either one of those tests has the same accuracy. The testing takes typically about two to three weeks to get back. Providing the sample actually is the really easy part of the testing. It’s figuring out if it’s a medically necessary test to do, and do people want that information. Deborah: It’s got to be a little bit mind-boggling. Do I want to know? Some people do. Some people don’t. Rayes: Those are some of the questions that we sit down and really talk about if someone’s ready for that information. Deborah: Who really needs genetic testing? Rayes: That’s a great question, because I think there’s a lot of missed information out there about this. Seeing an individual with the time that we spend going over that personal family history, it’s really figuring out if this is right for them, if this is something that’s medically necessary. Our community has a set of national guidelines that indicates who this is medically necessary for and who should be offered this testing. We really work off that and identify who has the greatest likelihood of testing positive. Deborah: When you say offer this testing, is testing something that’s usually covered by insurance? Rayes: That’s a great question. That’s something that I get asked a lot. If the test is medically necessary, it typically is covered. We meet those national criteria that we have, they typically meet their insurance criteria, although, of course, they vary. So one of the things that is confusing out there is I think some people think that Angelina Jolie was able to have this testing done because she’s a celebrity and has the money to pay for it. In fact, based on our family history, this is something she would qualify for. It was medically necessary for her to have it done. Anyone with a family history like that would also qualify by their insurance company. Deborah: I was amazed there are some haters out there that were just after her because she had the “money and accessibility” to do this. This is a devastating thing. This is a devastating choice. She’s done a fabulous job of keeping a bright spirit about the whole thing and is offering help to so many women. Where do you think that hate comes from? Rayes: There are a lot of individuals who don’t quite understand genetic testing. I think they think this is something that may be for the elite few or the individuals who have the money to do so. The way Angelina Jolie did was very admirable. She put all her information out there. There are many women who go through this and don’t actually talk about it. They don’t tell other individuals. It was very admirable that she was able to put that information out there. But everything that she did is really something that we see women going through all the time when they test positive, which is that we can get this covered by an insurance company. If a woman decides to do a surgery like she did, it’s covered, because we know that she’s at risk. It’s very unfortunate that we’ve seen some of that backlash for her. Deborah: It’s very empowering, actually. There’s no more pity, because if someone like Angelina can proudly do it and then go out and be on the red carpet in beautiful dresses and gowns with Brad Pitt on her, there is no shame, right? Rayes: That’s right. I think, one of the best things she could have done, was have a woman who’s really idolized and looked up to have something like this so that other women can know if they need to go through this, that that is all right. That is something that other people have been through. Everyone still looks at her, admires her and idolizes her. Deborah: And thinks of her as beautiful, because let’s face it, that’s part of it. Part of it is self-image. It’s probably a huge part of it if you’re thinking about losing both breasts. Not really losing, because you are also getting rebuilt. You’re not really losing anything that can’t be put forth in society and put right in that regard. Rayes: Many women are worried about losing what makes them a woman going through that and what are other people are going to think and how are they going to feel about it. So it makes it much more rare. It makes it something that’s discussed more and that’s a little bit more open conversation. That’s really the right way to go with this is that it’s something that just has everyone talking. Deborah: We want to thank you so much. I can’t believe how fast 11 minutes goes, especially when you put Angelina into the focus. Rayes: Amazing. Deborah: We want to thank you so much, Nadine, for finding the time to talk to us today about genetic counseling, and also for giving us some great information as to who a good candidate for genetic testing might be. Do you have any final thoughts? Rayes: It was my pleasure to be here. If anyone is ever concerned about this, the most important thing is talk to your family, talk to your physicians, and ask them if this is something that may be right for them. As long as we have everyone talking about this, we’re going in the right direction. Deborah: That’s right. Thank you again for your expertise. Thank you for all the wonderful work you do for our women. Rayes: Of course. It was so nice to be here. Thank you. Deborah: I’m Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have yourself a wonderful, wonderful day.
What to Know about Genetic Counseling
Deborah Howell (Host): Hello. Welcome to the show. You are listening to Weekly Dose of Wellness. It’s brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Nadine Rayes, a licensed and board-certified genetic counselor. She completed her Bachelor’s Degree in Biological Science at the University of California, Irvine and received her Master’s of Science in Human Genetics and Genetic Counseling from Stanford University. Nadine provides cancer genetic counseling at both Saddleback Memorial and Orange Coast Memorial Medical Centers within the Cancer Risk and Prevention Program. Her role involves providing cancer risk assessments based on medical and family history, discussing genetic testing options, and providing recommendations for preventive screening and surgical interventions. It’s a lot to say and it’s a lot to do. Welcome to you, Nadine. Nadine Rayes (Guest): Thank you so much for having me. Deborah: Today’s show is called “What to Know about Genetic Counseling.” There is so much to know, so first of all, what is genetic counseling, and what does a Genetic Counselor do for patients? Rayes: Genetic counseling is a consultation, essentially. What I do with patients is sit down and really provide a risk assessment by gathering personal family history information about an individual and seeing how likely it is that they have some hereditary cancers undermining in their family. Aside from that, if there isn’t one, how likely is it that they’ll develop cancer. By doing that, our goal is really to individualize a screening plan for them. Deborah: Can we jump right to Angelina Jolie? Can we just do that? Because it’s the elephant in the room, right? Tell us a bit about your take on what she did. You’re in the field. What would you say? Rayes: I think the story of Angelina Jolie is great because it’s gotten everybody talking about these cancer genes and about talking to each other within a family who has cancer and is it running in our family. Angelina Jolie tested positive for BRCA1, one of the most common hereditary cancer syndrome genes for breast cancer. Since she tested positive without having any cancer, she went ahead and had a preventative mastectomy to reduce that risk of breast cancer and essentially eliminate it. That choice is not for everyone, but it is the choice of many women who do test positive. Part of our role as genetic counselors is to sit down with those women and say how likely is it that this is in your family. If it is running there, what is the right choice for you? Maybe the same decision that she made, maybe something very different. Deborah: What can a woman expect in going in for genetic counseling, and about how long does it take? Rayes: It’s basically an office visit, sit down. And a good portion of the visit will be collecting that personal family history information. We try to have people do their homework before coming in and make those phone calls that they need to gather that information. Part of that is also educating and letting patients know what we are looking for, why we’re looking for it, and what the results may mean. That can lead us down the path to genetic testing, which we can do at that visit, or it may not lead us down that path. It may lead to, again, making those screening recommendations for the patient. Deborah: What’s the most common gene mutation that causes cancer? Rayes: Gene mutations are pretty rare in cancer-causing syndrome. They cause about 5 to 10 percent of cancers. It’s very small. We have a low threshold for investigating them because we know there’s so much we can do to be proactive and preventative. The most common genetic mutations that cause hereditary breast cancer are those BRCA1 and BRCA2 genes. It’s the one that are in the news right now because of Angelina Jolie. Deborah: Is that a simple blood test? How does that happen? Rayes: It’s a simple blood test. It could also be a saliva sample. Either one of those tests has the same accuracy. The testing takes typically about two to three weeks to get back. Providing the sample actually is the really easy part of the testing. It’s figuring out if it’s a medically necessary test to do, and do people want that information. Deborah: It’s got to be a little bit mind-boggling. Do I want to know? Some people do. Some people don’t. Rayes: Those are some of the questions that we sit down and really talk about if someone’s ready for that information. Deborah: Who really needs genetic testing? Rayes: That’s a great question, because I think there’s a lot of missed information out there about this. Seeing an individual with the time that we spend going over that personal family history, it’s really figuring out if this is right for them, if this is something that’s medically necessary. Our community has a set of national guidelines that indicates who this is medically necessary for and who should be offered this testing. We really work off that and identify who has the greatest likelihood of testing positive. Deborah: When you say offer this testing, is testing something that’s usually covered by insurance? Rayes: That’s a great question. That’s something that I get asked a lot. If the test is medically necessary, it typically is covered. We meet those national criteria that we have, they typically meet their insurance criteria, although, of course, they vary. So one of the things that is confusing out there is I think some people think that Angelina Jolie was able to have this testing done because she’s a celebrity and has the money to pay for it. In fact, based on our family history, this is something she would qualify for. It was medically necessary for her to have it done. Anyone with a family history like that would also qualify by their insurance company. Deborah: I was amazed there are some haters out there that were just after her because she had the “money and accessibility” to do this. This is a devastating thing. This is a devastating choice. She’s done a fabulous job of keeping a bright spirit about the whole thing and is offering help to so many women. Where do you think that hate comes from? Rayes: There are a lot of individuals who don’t quite understand genetic testing. I think they think this is something that may be for the elite few or the individuals who have the money to do so. The way Angelina Jolie did was very admirable. She put all her information out there. There are many women who go through this and don’t actually talk about it. They don’t tell other individuals. It was very admirable that she was able to put that information out there. But everything that she did is really something that we see women going through all the time when they test positive, which is that we can get this covered by an insurance company. If a woman decides to do a surgery like she did, it’s covered, because we know that she’s at risk. It’s very unfortunate that we’ve seen some of that backlash for her. Deborah: It’s very empowering, actually. There’s no more pity, because if someone like Angelina can proudly do it and then go out and be on the red carpet in beautiful dresses and gowns with Brad Pitt on her, there is no shame, right? Rayes: That’s right. I think, one of the best things she could have done, was have a woman who’s really idolized and looked up to have something like this so that other women can know if they need to go through this, that that is all right. That is something that other people have been through. Everyone still looks at her, admires her and idolizes her. Deborah: And thinks of her as beautiful, because let’s face it, that’s part of it. Part of it is self-image. It’s probably a huge part of it if you’re thinking about losing both breasts. Not really losing, because you are also getting rebuilt. You’re not really losing anything that can’t be put forth in society and put right in that regard. Rayes: Many women are worried about losing what makes them a woman going through that and what are other people are going to think and how are they going to feel about it. So it makes it much more rare. It makes it something that’s discussed more and that’s a little bit more open conversation. That’s really the right way to go with this is that it’s something that just has everyone talking. Deborah: We want to thank you so much. I can’t believe how fast 11 minutes goes, especially when you put Angelina into the focus. Rayes: Amazing. Deborah: We want to thank you so much, Nadine, for finding the time to talk to us today about genetic counseling, and also for giving us some great information as to who a good candidate for genetic testing might be. Do you have any final thoughts? Rayes: It was my pleasure to be here. If anyone is ever concerned about this, the most important thing is talk to your family, talk to your physicians, and ask them if this is something that may be right for them. As long as we have everyone talking about this, we’re going in the right direction. Deborah: That’s right. Thank you again for your expertise. Thank you for all the wonderful work you do for our women. Rayes: Of course. It was so nice to be here. Thank you. Deborah: I’m Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have yourself a wonderful, wonderful day.