Amanda Wilde (Host): The more we discover about genetics, the more we can see how our genetics impact our physical fitness. Next, we explore the connection between heredity and health with genetics counselor Alexandrea Wadley from the UAMS Winthrop P. Rockefeller Cancer Institute.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Amanda Wilde. Alex, thank you so much for being here.

Alexandrea Wadley: Thank you for inviting me.

Host: Well, your specialty in Genetics is Oncology. So, let's talk about hereditary cancer. What is that?

Alexandrea Wadley: So, hereditary cancers are cancers that are due to a genetic mutation that was inherited. So, people were born with this. And often, these types of cancers occur in younger individuals or people who have a family history of cancers and have an increased risk or predisposition to develop certain cancers throughout their lifetime.

Host: You mentioned younger individuals have this, and probably it would behoove them to get tested, but what makes someone a good candidate for genetic testing? How do you know you should be tested?

Alexandrea Wadley: So, that's where a genetic risk assessment can be really beneficial to determine if a person would be a good candidate or might meet national recommendations for consideration of genetic testing. And some of those indications would be if a person has been diagnosed with cancer at a younger age. So, we define that really fifties or younger. If a person has had more than one type of cancer, if they've had a rare type of cancer, such as ovarian or pancreatic cancer. And again, this would also apply to individuals who they themselves do not have a diagnosis of cancer, but have a family history that could be suggestive of that as well. So, multiple people in the family and subsequent generations. An example being mom, aunts, grandparents, who might have all had various cancer diagnoses.

Host: So, knowing your family history is really important.

Alexandrea Wadley: Yes.

Host: And once you've done the genetic testing, what information do you get back from that? What does it overall tell you?

Alexandrea Wadley: Yes. So if a person has had cancer themselves, genetic testing could provide an explanation, perhaps why they developed cancer, but the results can also be really beneficial for helping doctors guide surveillance, potentially impacting treatment plans or for individuals who have a family history, the genetic testing results can be helpful to help personalize the cancer screenings of ages of when they might begin. So for women with an increased risk of breast cancer, perhaps starting before age 40 and then the frequency of those screenings. So, how often they need to go for different cancer screenings.

Host: And is that what you do? Do you counsel people once you've gotten those results about what their next step should be.

Yes. So at a cancer genetic counseling appointment, we would meet with patients. And review their health history, their family history; discuss the intricacies of genetic testing and how results-- you know, they can be complex-- and how it might impact them in their downstream screenings and what it could mean for family members. So, we talk about the testing at an initial appointment. And if a person elects to undergo testing, at a followup appointment, we would then review those results in detail and discuss and come up with a good management plan for the patient. And I can coordinate getting them in with various specialties, and then also what it means for family members and then can coordinate family member testing as well.

So, your job is to counsel people once you have the results of that genetic test, maybe family members as well. And then, what is your role further down the road for that patient? Or is that the end of your role as genetic counselor?

Alexandrea Wadley: So largely, I would say we're a point of contact to serve as the genetics expert to answer questions as they may come up surrounding a person's test results and also answering questions as it may pertain to surveillance. As patients test positive, we're there to oversee and make sure they get plugged into the appropriate clinics for various screenings and can also be there to update patients as we learn more information about these test results and how new screenings may be recommended, for example.

Host: So, you are really the bridge between the genetic testing and interpreting that testing, and then figuring out how to network within the system to get the treatment needed.

Alexandrea Wadley: Absolutely. And I would also add that we're there for the patients and their families. But we're also there for other healthcare providers to educate them because genetic testing is ever-evolving and we are constantly learning more and more about these hereditary cancer conditions. And part of my job is to educate other healthcare professionals just about the changes in testing guidelines or screening guidelines.

Host: Yeah, because this is a constantly evolving field.

Alexandrea Wadley: Yes.

Host: Do people get referred for genetic testing or can they decide themselves? And does insurance cover genetic testing?

Alexandrea Wadley: So for our clinic at UAMS, we ask that referrals be sent to us and that could be from really any healthcare provider. Most often, it's coming from a Family Medicine doctor or an OB-GYN, for example, but it may also be coming from a medical oncologist if a patient is undergoing treatment, where referrals are sent to our clinic. And then, your second question was about the insurance coverage. And yes, absolutely, many insurances do cover testing. That's where it comes into play if a patient meets the national recommended criteria. And that's where myself or other genetic counselors would review the health and family history to determine eligibility.

Host: Right. Because all insurance companies ask about necessity of treatment. So, this is just like any other screening you might get done.

Alexandrea Wadley: Yes. And we're very used to that too. And what those requirements often are.

Host: So, you know how to work with the insurance system.

Alexandrea Wadley: Yes.

Host: And lastly, you've been doing this 11 years, how have you seen genetic testing affect cancer or patient outcomes?

Alexandrea Wadley: Oh my gosh. It has changed so much. It's really night and day from when I first started practicing where now we know about many, many different cancer predisposition genes, where in the past it was just a handful. And then, from that, we've also seen the evolution of integrating that into practice for personalized medicine.

So now, with certain genetic mutations, so I'm going to use an example to illustrate my point. So, the BRCA genes, so BRCA1 and BRCA2, which increased risk for various cancers, including breast, ovarian for women, we've now seen that there's FDA approval for maintenance chemotherapy for these individuals who have a BRCA1 or 2 mutation and are undergoing cancer treatment. So, we know that they may respond better or may be placed on a maintenance chemotherapy drug that's tailored to their genetic mutation, which is great. And I'm sure opens the door for future genetic mutations of different genes to also be factored in with more personalized treatment for our patients.

Host: That's a huge plus, more focused treatment that is individualized for each patient.

Alexandrea Wadley: Yes. And I'm sure it's only going to continue to evolve and new treatments become available and also probably more sensitive screening modalities as well.

Host: Well, Alex, thank you so much for the work you do providing crucial information and integrating genetic information within the healthcare system with patients and also keeping on top of these developments in this growing field.

Alexandrea Wadley: Thank you so much for having me.

Host: That was Alexandrea Wadley, Genetics Counselor at the UAMS Winthrop P. Rockefeller Cancer Institute. Appointments for new patients are by referral only. Existing patients can make an appointment by requesting an appointment online through UAMS Health myChart or by contacting the clinic directly at 501-526-4812. If you found this podcast helpful, please share it on your social channels, and check out the entire podcast library for other topics of interest. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.