Genetic Testing: How Understanding Your Genetic Make-Up Can Help You Determine Your Risk For Cancer

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hey there everybody, welcome to the program. And you are listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Health System and I'm Deborah Howell. Today's guest is Karen Lappen, genetic counselor at Long Beach Memorial MemorialCare Todd Cancer Institute. She's a certified genetic counselor with a Master's of Science in genetic counseling specific to cancer genetics and patient and family counseling. She's a member of the American Board of Genetic Counselors and the National Society of Genetic Counselors. So by that description you could probably guess that today we'll be talking about genetic testing and how you can understand your genetic makeup which can help determine your risk for cancer. Welcome, Karen.

Karen Lappen, MS, CGC: Thank you for having me.

Deborah Howell (Host): Would you prefer me to call you Ms. Lappen?

Karen Lappen, MS, CGC: No, Karen's good, thanks.

Deborah Howell (Host): Okay. All right, what is hereditary cancer and why is a hereditary cancer risk assessment so important?

Karen Lappen, MS, CGC: Hereditary cancer is about 5 to 10 percent of all cancers that are diagnosed in the United States and across the world. And it's the development of a cancer that's due to a genetic change or a mutation in our DNA that can be passed on from parent to child. So it's important to receive a genetic risk assessment to discuss an individualized plan for cancer screening and prevention options.

Deborah Howell (Host): So who should consider getting genetic counseling? Everybody or just a certain segment?

Karen Lappen, MS, CGC: Well that's a very good question. A lot of people can benefit from genetic counseling focused on cancer. To name a few people that may benefit more than just individuals in the general population. A person who has a strong family history of cancer, meaning if they have two or more relatives on the same side of the family with the same cancer or related cancers, especially if some of those cancers were diagnosed early. For example, if you have a mother and an aunt who were diagnosed with breast cancer and one of them was diagnosed in her 40s, that may be a reason to get genetic counseling. Also, a person who may have had more than one type of cancer diagnosed, and also individuals who are just anxious about their family history of cancer and who just want to know more about the role of genetics in cancer.

Deborah Howell (Host): Okay, sounds good. So it is open to everybody. You don't have preconditions to be, you know.

Karen Lappen, MS, CGC: That's correct.

Deborah Howell (Host): Okay, great. So what happens when you get there and you have your first genetic counseling consultation?

Karen Lappen, MS, CGC: So in a first genetic counseling consultation, typically a patient will meet with me, the genetic counselor, or if they go to a different location, they'll meet with somebody who does an intake of their family history. They'll ask them questions about family members who've been diagnosed with cancer, what type of cancer they were diagnosed with, how old they were when they were diagnosed with that cancer to get an overall kind of picture of a family's history. And then I would typically discuss the role of genetics of cancer and specifically focus on cancer based on their own family history that we've just gone over. And then talk a little bit about genetic testing and if that's an option for them and if they're interested in pursuing that, we can discuss what that genetic testing may tell us, what that genetic testing may not tell us, and why we would utilize that information.

Deborah Howell (Host): And how long does the first session typically take?

Karen Lappen, MS, CGC: It typically takes about 45 minutes to an hour, sometimes less, sometimes more. It really is dependent on the person that comes in.

Deborah Howell (Host): And what do I, as the patient, have to do for a genetic analysis?

Karen Lappen, MS, CGC: That's a very good question. So usually if you meet genetic testing criteria, it depends on the laboratory that we do the testing from. Sometimes you would just need to give a blood sample. Sometimes you would need to give a saliva sample. So it's a pretty low risk for you. And then we would just send that sample off to a genetic lab for analysis.

Deborah Howell (Host): Well, that doesn't sound very, very hard at all.

Karen Lappen, MS, CGC: No, it's not. We’re pretty painless.

Deborah Howell (Host): I was expecting much more! Well, how many types of cancers would I be able to find out my risk for during this?

Karen Lappen, MS, CGC: Well, hereditary cancer assessment is very individualized. So we would base somebody's cancer risk based on their family history, their personal medical history, and whether or not a person carries a genetic mutation for a cancer predisposition. So we wouldn't discuss all types of cancers with one person. We would really discuss the cancers based on their own family history and talk to them about what screening and prevention options they could use.

Deborah Howell (Host): Okay, now obviously there are some people who don't have access to their family history.

Karen Lappen, MS, CGC: That's correct. We do see patients that have been adopted and don't know anything about their family history, so that gets a little bit more tricky because we don't have the background to use, But we could use a person's own medical history and discuss just screening and prevention options that are good for them. So for any woman, we would say, if you don't know your family history, go ahead and get your mammogram starting annually at 40 years and colonoscopy starting at 50 years as recommended by the cancer societies.

Deborah Howell (Host): Sure. So that means you have a baseline to work from.

Karen Lappen, MS, CGC: Exactly.

Deborah Howell (Host): Okay. So, do not despair if you don't have your family history, but this would be a good time to start compiling it if your parents are still alive and if your grandparents are still alive. Get that information.

Karen Lappen, MS, CGC: Agreed, agreed. It's a great time, you know, Thanksgiving table or Christmas table. Go ahead and sit down and ask some questions because we do see a lot of patients who don't know too much information aside from their parents and maybe their aunts or uncles. So it's a great way to kind of start the conversation.

Deborah Howell (Host): That's right, especially after dinner.

Karen Lappen, MS, CGC: Yes, definitely. If it becomes heated, yes.

Deborah Howell (Host): That's right, after the pumpkin pie, retire to the drawing room and have the conversation.

Karen Lappen, MS, CGC: Yes, definitely.

Deborah Howell (Host): All right, how long do the results typically take and then what are the next steps after I get those results?

Karen Lappen, MS, CGC: Well, it depends on the type of genetic test that is ordered. So sometimes the genetic test results can take anywhere from 10 days to two weeks, but sometimes they may take months. So it ranges anywhere from two weeks to about four to five months for genetic test results.

Deborah Howell (Host): So you have to be a little patient, folks. You're not gonna get your answer the next day.

Karen Lappen, MS, CGC: Yes, sometimes you just kind of have to wait it out. And usually once we get the test results in, we will meet with the patient again to discuss those test results and work out a screening and prevention plan for that patient based on those test results. And again, based on their family history and their personal history.

Deborah Howell (Host): Okay, and what age would you start recommending getting genetic counseling?

Karen Lappen, MS, CGC: Well, that again is very individualized. Usually for a lot of our cancer syndromes that we see, these tend to be cancers that develop when you're an adult. So usually it's not recommended that individuals get genetic testing until they're 18 or old enough to make that decision on their own. We'd really want to…

Deborah Howell (Host): Not because the body is not ready for it, but you're talking about a maturity level.

Karen Lappen, MS, CGC: Yes, yes, a maturity level. And a lot of our screening prevention options wouldn't start until a person is in their 20s anyways. So this would be information that wouldn't be utilized right away until somebody is in their 20s.

Deborah Howell (Host): Okay, that's fair. Even if you have both parents and both grandparents, it's not really gonna do you much good if you're 14 years old to get genetic…

Karen Lappen, MS, CGC: Yes. And usually we say we should start screening and prevention options about 10 years before the earliest cancer diagnosis. So if your mother had breast cancer at 43, we would say you should start your cancer screening at 33, about 10 years before the earliest.

Deborah Howell (Host): Sounds good. Where can I learn more about genetic counseling at the MemorialCare Todd Cancer Institute?

Karen Lappen, MS, CGC: To schedule a genetic counseling consultation or to learn more about genetic counseling and genetic testing, you can contact our cancer risk and Prevention Program. The telephone number is 562-933-7475 or you can visit us at memorialcare.org/tci.

Deborah Howell (Host): Fantastic. All right, Karen, what else do we need to know about genetic testing?

Karen Lappen, MS, CGC: I think we've covered a lot. So, you know, everybody has their own family history and everybody has their own questions and we would be happy for people to contact us with their own questions and see if they may benefit from a genetic consultation.

Deborah Howell (Host): Okay, and say somebody did take the counseling and they did find out that they were at extreme risk. What's the next step?

Karen Lappen, MS, CGC: Well, the next step would be to work out a plan in terms of screening and prevention options. And so we would just talk to them about what they can do in terms of their screening options and work out a plan with that person that's best for them.

Deborah Howell (Host): Okay, and do you have a place for them to go once you have the plan in place that's right there at MemorialCare Todd Cancer Institute?

Karen Lappen, MS, CGC: We do, luckily we're a very comprehensive cancer center, so we would typically work with that patient's primary care physician or their gynecologist or gastroenterologist and come up with a plan that they can just go and come here to Todd Cancer Institute and get an overall care.

Deborah Howell (Host): That is wonderful. It's a one-stop shop kind of situation.

Karen Lappen, MS, CGC: One-stop shop.

Deborah Howell (Host): And very little invested on your part, just a little saliva and maybe a blood test.

Karen Lappen, MS, CGC: Yeah, and a little bit of time.

Deborah Howell (Host): A little bit of time and a little bit of bravery.

Karen Lappen, MS, CGC: That's true.

Deborah Howell (Host): Karen, Ms. Lappen, thank you so much for joining us on the show today.

Karen Lappen, MS, CGC: Thank you very much for having me.

Deborah Howell (Host): It was really, really interesting to have you here and to learn about genetic testing and how it can help us determine our risk for cancer. I'm Deborah Howell, hoping you'll join us again next time as we explore another weekly dose of wellness. It's brought to you by MemorialCare Health System. Have a great, healthy, happy day.