Cancer Genetic Counseling: Can Hereditary Cancer Be Prevented?

We're all familiar with the phrase, "You get that from your dad." (Or, "You get that from your mom.")

From eye color to hair color to the freckles we may have, we often think visually when it comes to what our parents have passed down to us.

And while we certainly do get our looks from our parents, physical traits aren't all we can inherit.

"Unfortunately, health conditions can run in the family, too. It's all in our genes. Just as we inherit our eye color, we can also inherit an increased risk of developing certain diseases, including cancers," says Tiffiney Carter, genetic counselor at Houston Methodist.

This is why it's important to know your family's history with cancer and what to do if you're at increased risk of developing hereditary cancer.

When is cancer hereditary?
"Cancer is a genetic disease — caused by changes that can occur in our genes. Genes provide the instructions that guide everything happening in our bodies," says Carter. "These genetic changes can be acquired over the course of our lives, or they can be ones we're born with — passed down to us by our parents."

It's normal for genes to collect small changes over time.

Fortunately, the vast majority of these changes are insignificant — having no effect on a person at all.

"In some cases, however, certain types of genetic changes can increase an individual's chance of developing cancer. These types of changes, or mistakes, can be acquired or inherited genetic changes," explains Carter.

Additionally, the familial genetic mistakes that lead to cancer can even be passed from parent to child. When this happens, it's an inherited genetic change.

"Any type of cancer caused by a change in a gene (or changes in genes) inherited from a parent is called a hereditary cancer," explains Carter. "These cancers often run in the family and account for around 10% of cancers diagnosed each year."

Factors that may put you at a higher risk of developing hereditary cancer include:

• Personal or family history of cancer occurring at or before age 50
• Personal or family history of one or more cancer diagnoses
• Family history of carrying a change in a gene that's known to cause cancer, such as BRCA1, BRCA2, MMR genes, PTEN, TP53 and more
• History of cancer in multiple close relatives (on one side of the family)
• Personal or family history of rare types of cancer
• Ashkenazi Jewish ancestry on one or both sides of the family
  
  

Can hereditary cancer be prevented?
When it comes to cancer prevention, there are many cancer risk factors you can do something about, like wearing sunscreen, avoiding certain unhealthy lifestyle behaviors/choices and following the recommended cancer screening guidelines.

Then there are the risk factors you may have that you can't control. For instance, a genetic change linked to cancer that you were born with.

"But this doesn't mean that hereditary cancers aren't preventable," adds Carter. "People with family history of cancer are more likely to develop cancer themselves — but this does not mean that they will."

The goal is to help individuals determine their risk, and to lower that risk when possible.

"If we are aware of the risk, we can screen that individual earlier and more often or even offer significant risk reduction options in some cases. It's true that even if there is a hereditary or genetic predisposition, that does not mean the person will get cancer. However, we would like to watch them a bit closer, though. If something does come up, we can catch it at the earliest stage possible when it's most curable," Carter adds.

She also says there are steps you can take to reduce your risk, starting with consulting a cancer genetic counselor.

What is genetic counseling for cancer?
Just because cancer runs in your family, doesn't mean you're going to get cancer yourself.

"It's really important to understand how your family health history might affect your own health," says Carter. "A cancer genetic counselor can help determine whether your family cancer history and genetics actually increase your risk of developing cancer, and to what extent."

A genetic counselor can recommend ways to reduce your cancer risk, including:

• Being screened for cancer more regularly
• Preventive surgeries and medications
• Genetic testing
  
  

"I'm often asked about genetic testing, particularly when it's needed and if it's a good idea. The short answer is: It depends," says Carter.

National guidelines and/or your counselor may recommend genetic testing in some cases, but not all.

"Genetic testing may be particularly important if you have a hereditary cancer and are planning a family," adds Carter. "The choice to proceed with genetic testing is ultimately yours, but your cancer genetic counselor will be supportive while helping you make the decision that's best for you and your family's health."

It's also important to know that this option is available to you. Ask your provider for a referral for genetic counseling services to assess your personal risk and determine if genetic testing is right for you.

"This is particularly something that we are concerned about in minority populations because research has shown that minorities are less likely to be offered a genetic counseling referral or the option of genetic testing," says Carter. "This leads to health care disparities and the inability to empower the patient and family members to make informed health decisions in advance."

In addition, a cancer genetic counselor can also help you understand the cancer risk of your immediate family members, including your children, and offer information and support as you inform them about their possible risk factors.

"When it comes to hereditary cancer, the more information available and the sooner you can act on the information the better. By consulting with a cancer genetic counselor, you can get invaluable help as you learn about your risk and make the decisions that can help reduce this risk," adds Carter.