HJLR Mar/Apr 2019

Healthcare Journal of little rock I  MAR / APR 2019 53 Marianne Lotito, MS, CGC Genetic Counselor CARTI Cancer Center cancer, but also ovarian, pancreatic, and prostate cancers. In fact, the risk for ovari- an cancer is 63 percent, in comparison to 1 in 71 for all women. Ovarian cancer is par- ticularly dangerous because it often is not detected early. Women with a gene mutation may also be advised to take the birth control pill to reduce the risk of ovarian cancer, or tamoxifen, which can reduce the risk of breast cancer. Preventive surgery is another possible option. Women at high risk for ovarian cancer may have their ovaries removed after childbearing is complete. While hereditary breast cancer and the BRCA genes receive more attention, there is another hereditary cancer syndrome that is just as common. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, is an inherited disorder that increases the risk of many types of cancer, especially cancers of the colon and uterus. For most people, guidelines call for the first colonoscopy at age 50. However, if we know a person has a mutation in one of the Lynch genes, the recommendation would be to start colonoscopy at a young- er age (40 years old) and screen annually. In general, a pre-cancerous polyp that is left in the colon long enough will go on to become cancer. If we screen patients with colonoscopy more often, we increase the chance of finding a polyp early, before it has a chance to progress to colon cancer. For patients with a mutation in one of the Lynch genes, colonoscopy helps to prevent cancer or detect it earlier, which ultimately helps lower the mortality rate. Misconceptions about Cancer Genetic Counseling Although a law against it was passed in 2008, the misconception persists that health insurance coverage or employ- ment can be denied based on the results of genetic testing. The Genetic Information Nondiscrimination Act (GINA) is a federal law that protects people from genetic dis- crimination in health insurance and em- ployment. We also have additional laws on the state level here in Arkansas. Many people are understandably anx- ious when they learn they are at an in- creased risk for cancer. But the truth is that although mutations in some genes may predispose individuals to cancer, not all people who carry these mutations de- velop cancerous tumors. We don’t want people to live in fear; we want them to feel empowered. Genetic testing provides an opportunity to know if there is a potential for a diagnosis; it provides a little bit of control. The Future of Cancer Genetic Counseling While genetic testing has been avail- able through oncologists for a number of years, it has been up to the clinicians to try to keep up with advances in the rapidly evolving field of genetics while simultane- ously maintaining expertise in their own specialty. The cancer care team wants to be consistent across the practice, which includes establishing guidelines for who to test, as these standards change every year. The next step is to look at patients who are cancer survivors but may be 20 years out. They may be at increased risk for other cancers, and we want them to have the op- portunity to decide for themselves wheth- er to have genetic testing. As opposed to BRCA-only analyses in women with breast cancer, multigene test- ing may detect a mutation in another gene that also impacts cancer risk. It provides more clinically useful information for pa- tients and their relatives. But in order to be most successful, greater access to genetic testing is necessary. More genetic counselors are needed to be integrated into standard cancer care. If we’re missing people who may have a mu- tation, they might not be able to take steps to reduce their risk of cancer. n Marianne Lotito, MS, CGC, has returned to Arkan- sas to implement CARTI’s new genetic counseling program after developing similar programs in Se- attle and the Northwest. She has 20 years of ex- perience in genetic counseling, including program implementation of genetic testing for hospitals and oncology practices around the country, as well as direct patient care. She holds amaster of science in genetic counseling degree from University of Pitts- burgh and is board certified by the American Board of Genetic Counseling. She is a member of the pro- fessional education committee for the Arkansas Cancer Coalition.