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Frequently Asked Questions
Is cancer genetic?
Everyone has some chance of developing cancer. Most cancer cases occur sporadically or by chance. However, approximately 5-10% of cancer is hereditary.

Hereditary cancer is the development of cancer due to an inherited gene mutation (changes in a specific gene) that has been passed from a parent to a child upon conception. If a person has inherited such a gene mutation, he or she has inherited an increased risk to develop cancer in their lifetime, which is higher than the cancer risk of someone in the general population.

Specific genes have been identified that can contribute to the development of hereditary breast, ovarian, colorectal, and other less common cancers. Genetic testing is now available for some of these types of hereditary cancers.

What is genetic counseling?
Cancer genetic counseling involves a discussion of your personal and/or family history of cancer. Genetic counselors will simplify complex scientific concepts into terms you can understand. The goal of cancer genetic counseling is to provide clear and clinically relevant information about genetic risk factors in an atmosphere of support and education.

Who are genetic counselors?
Genetic counselors are health professionals with graduate degrees and experience in the areas of medical genetics and counseling. Genetic counselors have specialized training in cancer genetics for risk assessment, ordering and interpreting test results.
Most major medical societies recommend genetic counseling both prior to and after genetic testing for hereditary cancer. This is due to the fact that the cancer genetic counseling and testing process (including which test to order and interpreting the results correctly) can be quite complex. Studies have shown a high rate of genetic test result misinterpretation among providers who do not specialize in this area.

Who should have a cancer genetics consultation?
Multiple relatives on the same side of the family with the same cancer or related cancers e.g. breast/ovarian/pancreatic colon/uterine/ovarian
Cancer at unusually early ages (ex. breast cancer <45 years, colon cancer <50 years)
More than one diagnosis of cancer in the same individual (ex. breast and ovarian cancer in one person; colon and uterine cancer in one person)
Rare cancers (ex. male breast cancer; medullary thyroid cancer)
A family history of a known altered cancer-predisposing gene

What should I do prior to my appointment?
You will be asked to complete the cancer family history forms (found on the FORMS page). Please give yourself time to complete the form. You may find it helpful to talk to your family members to find out as much medical information as you can. It is important to gather the following information, if possible:
Type of cancer (e.g., breast, colon, ovarian, etc.)
Age cancer was diagnosed
Current age. If deceased, age and cause of death (may or may not be from cancer)
Clarify whether the cancer was unilateral (e.g., one breast) or bilateral (e.g., both breasts)
Clarify whether the family member with cancer developed a second cancer. If yes, it is important to try to • • • • • Clarify whether the second cancer was a metastasis (spread from the first cancer), or a new primary cancer (new separate cancer)
Correct information about the types of cancer in your family is very important in assessing cancer risk. It may also be helpful to locate medical records from family members who had cancer. These records include pathology reports of tumors, surgical reports and hospital discharge summaries regarding their cancer course.
We understand you may be unable to collect all the information about your family history of cancer. Genetic counseling will be based on the information that you can provide.

What can I expect during my first visit to a genetic counselor?
The first visit is typically 90 minutes, where the genetic counselor will review your family medical history, and help you understand the role of genes in causing cancer. The genetic counselor will perform a cancer risk assessment based on the information you provide. We will discuss the chance that a risk for cancer might be passed through the genes in your family and discuss any genetic testing that could be helpful for your family. We will also give you a general estimate of your personal cancer risks. During the risk assessment, we will discuss appropriate screening and prevention for you and your family. If testing is elected, the blood can usually be drawn that day. Please drink plenty of water before your visit to help hydrate your veins and make that process easier.

What is genetic testing?
Genetic testing involves the use of laboratory methods, typically from a blood sample (fasting, etc not required, but drinking plenty of water is recommended). In some cases there are other options besides blood. Genetic testing is used to obtain a more precise estimate of your cancer risk and in some cases may help you and your physician make important decisions about your medical care.

I just want genetic testing; why do I need genetic counseling?
Genetic testing is not recommended for everyone and the genetic counseling process helps to decide if genetic testing is right for you. Genetic testing for a family usually begins with a family member who has had cancer. Individuals should thoroughly consider whether or not to have genetic testing. During the genetic counseling visit, we will discuss any concerns you may have about genetic testing as well as possible results, benefits, risks and limitations of the testing. We will also discuss cost, insurance coverage and issues of genetic discrimination.

I do not need genetic counseling because I do not want to have genetic testing.
You will have a cancer risk assessment during your first visit to genetics. At that time, we will discuss the risk for hereditary cancer in your family. We will also discuss whether or not genetic testing could be helpful for your family. In some cases, risks of cancer can be determined without testing. In some cases, a cancer genetics risk assessment may indicate that a person's risk for cancer is lower than they thought are people may be reassured by a visit.
We strongly believe that deciding whether or not to undergo genetic testing is a personal choice and therefore support each person's decision. The decision can be made at the time of the counseling session or at a future date. The genetic counselor is here only to give you the information that you need to make an informed decision about what works best for you and your family.

How do I receive my genetic test results?
At the time of your blood draw, the genetic counselor will discuss with you the estimated length of time it will take the lab to analyze your sample. The range is usually two-six weeks.
As consistent with the goals of genetic counseling and testing, an in-person appointment is generally required to discuss your genetic test results. This is due to the fact that testing is a complex issue and depending on the results, specific recommendations will be made for you and your family. We understand that your time is important, however this appointment is critical in providing the most complete and comprehensive care.

How would I use the results of genetic counseling and testing?
This information will help to estimate a person's true risks of developing cancer, and to develop a personalized plan for surveillance and management based on those risks. This can allow for interventions that can reduce the chance of a person ever developing cancer. It can also be very useful to the entire family. We discuss these issues, in depth, in the counseling sessions.

Will my insurance pay for genetic consultation?
Most insurance companies cover the consultation charges, however some plans have copays or deductibles. Billing is for a new patient consultation under our Medical Geneticist R. Nathan Slotnick. Check your insurance policy to see if you generally require a referral to a specialist from your primary care physician.

Will my insurance pay for genetic testing?
After your first session we will determine which genetic test, if any, would be most appropriate and whom in the family (ideally) should be tested first. We will discuss the cost of that testing and, at your request, will navigate the insurance authorization process for you. Despite common misconceptions, most insurance companies do pay for all or a portion of testing. Letters of medical necessity are sometimes required and we will write such a letter for you if needed.

Are there risks of billing these costs to my insurance company?
It does not appear that billing health insurance companies for cancer genetic counseling or testing represents a major risk. Most states have laws that protect unaffected individuals from discrimination in regard to their health insurance and employment. Also, in 2008 the Genetic Information Nondiscrimination Act (GINA) was passed. This is a federal law that protects these rights.
Cancer Genetics Risk Assessment