Appropriate genetic referrals during cancer care may reduce mortality and improve survival for relatives at risk. By providing timely referrals and appropriate genetic testing of the cancer patient, health care professionals can target screening and preventative treatments for at-risk family members.
According to the Commission on Cancer (CoC), “Cancer risk assessment and genetic counseling are the processes to identify and counsel people at risk for familial or hereditary cancer syndromes. [The] purposes of cancer genetic counseling are to: educate patients about their chance of developing cancer, help patients obtain personal meaning from genetic information, and empower patients to make educated, informed decisions about genetic testing, cancer screening, and cancer prevention.”
Timely Referrals Improve Detection of Familial Cancer
A study published in the Journal of Palliative Medicine identified that family members affected by cancer are commonly deceased by the time that patients are referred to cancer genetics services. In fact, two-thirds of the referrals in this study could have been made earlier. Delayed referrals can make genetic testing and risk assessment more difficult, reducing the benefit of screening and preventative treatment for unaffected relatives. This means missed opportunities to prevent, detect, and manage individuals who are at risk of developing familial cancer.
Family History Can Identify Patients Eligible for Testing
Genetic testing of living family members affected by cancer can identify if unaffected family members are predisposed to certain types of cancer. Multidisciplinary healthcare practitioners including primary care and specialties such as gynecology, colorectal and palliative care can use family history information at any point in the cancer care continuum to identify patients diagnosed with cancer and their family members who would potentially benefit from genetic counseling and subsequent genetic testing when appropriate. However, this study highlights that this referral process is not taking place in a consistent manner.
The use of a clinical support tool such as MyLegacy can improve the quality and consistency of family medical history information collected and identify individuals who would benefit from genetic counseling. A genetics professional can then review available options for the family, identify which family members should be offered testing and coordinate recommendations with their health care provider.
Cancer Care Programs Need Referral Guidelines
Genetic testing is not just about one family member. Test results may have implications for an entire family. Early identification of at-risk family members through appropriate genetic referrals can facilitate targeted screening and preventative treatments. It is important for cancer programs to implement policies and procedures incorporating evidence-based guidelines for genetic counseling and risk assessment services. Identification of those who would most benefit from a cancer genetics risk assessment and increased consistency of referral rates will improve the potential for survival of relatives at risk.