Cancer Risk and Genetics
Genetic Counseling and Testing Services
What is Hereditary Cancer | Who We Are | Helpful Resources |
Internship Opportunities | Contact Us
Overview:
Genetic Counseling and Testing Services at the Moffitt Cancer Center provide cancer risk assessment, education, and research. By identifying high risk families we can help them understand their risk for developing cancer as well as their options for prevention, early detection, and treatment.
What is inherited cancer risk?
- Hereditary cancers are caused by a change (mutation) in certain genes. The gene changes:
- May be passed down from mothers OR fathers to their children.
- May increase a person’s risk for developing one or more types of cancer (however all people who inherit the changed gene may NOT develop cancer).
- Most cancers are sporadic, or happen by chance, and occur in patients without a family history. (These cancers are not inherited)
- Approximately 5-10% of all cancers are “inherited” or “hereditary.”
Red Flags
What features make inherited cancer risk more likely in my family?
- Two or more people, on the same side of the family, have the same type of cancer.
- Cancer diagnosed at age 50 or younger.
- Cancer in paired organs (e.g. both breasts, both eyes, etc)
- The presence of a very rare cancer (e.g. male breast cancer)
- A single person has more than one type of cancer (e.g. both colon and uterine cancer OR both breast and ovarian cancer).
- Cancer in two or more generations.
- Ethnic background (for example BRCA mutations are more common in those of Ashkenazi Jewish ancestry).
There may be one or there may be several of these features in a family.
What happens if I see a genetics professional?
Your personal and family cancer history will be reviewed, including type(s) of cancer and age(s) of diagnosis. Then, based on this information, a genetics professional will:
- Evaluate your risk of inherited cancer.
- Discuss genetic testing options available to evaluate your risk of cancer.
- Discuss the benefits and limitations of testing, including insurance coverage and confidentiality.
- Help you decide if genetic testing is right for you.
- Explain the procedure for ordering genetic testing.
- Talk to you about medical management options based on your family history and/or testing options.
- Discuss the emotional impact of the information on you and your family.
- The visit may be referred to ask a “genetic counseling session.”
Expectations of a Genetic Counseling Session
To schedule a genetic counseling appointment, please call (813)745-6769.
Frequently Asked Questions
Who are Genetic Counselors?
What are the reasons to have cancer genetic counseling?
Why do people want to know their cancer risk?
What happens during the first genetic counseling appointment?
Will more than one visit be required?
How might I use the results of genetic counseling and testing?
I’ve already had cancer. Why should I be tested?
Is genetic counseling the same thing as genetic testing?
What is the difference between OncotypeDX™ testing and genetic testing?
May I bring someone with me?
I want genetic testing. Do I need to have the genetic counseling?
Will my insurance cover the cost of the genetic counseling visit?
Will my insurance cover the cost of genetic testing?
How do I make an appointment?
Is there anything I need to do prior to my appointment?
What about insurance discrimination, should I be concerned?
Who are genetic counselors?
Genetic Counselors are health care professionals with specialized graduate degrees and training in medical genetics and counseling. Genetic counselors work as part of a medical team consisting of medical geneticists (physicians specializing in genetics), nurses, oncologists, social workers, and others.
What are the reasons to have cancer genetic counseling?
Cancer genetic counseling may be beneficial for families that have any of the following:
- Two or more people, on the same side of the family, have the same type of cancer.
- Cancer diagnosed at age 50 or younger.
- Cancer in paired organs (e.g., both breasts, both eyes, etc)
- The presence of a very rare cancer (e.g., male breast cancer)
- A single person has more than one type of cancer (e.g., both colorectal and uterine cancer OR both breast and ovarian cancer).
- Cancer in two or more generations.
- Ethnic background (for example BRCA mutations are more common in those of Ashkenazi Jewish ancestry).
Why do people want to know their cancer risk?
People want to know their cancer risk for many different reasons. The most common reasons are to:
- understand the risk of cancer for themselves or their children
- discover if inheritance played a role in the development of their cancer or a family member’s cancer
- obtain information about cancer screening tests, such as mammography or colonoscopy, and about how often the tests should be done
- make decisions about the use of medical or surgical options to manage their higher cancer risks
What happens during the first genetic counseling appointment?
The first genetic counseling appointment generally takes 1½ -2 hours. In order to provide you with appropriate information, the genetic counselor will first gather information from you about your personal medical history and family cancer history. After identifying your concerns, the consultation team will discuss:
- The possibility of an inherited risk for cancer in your family
- Your estimated risk of developing certain types of cancer based on your age, family history, and other factors
- Screening tests or other options available for managing your risks for cancer
- Emotional issues surrounding cancer and risk
- The impact of genetic testing on family members
- The availability of genetic testing
If genetic testing appears to be an option for your family, the benefits, risks and limitations of genetic testing will be reviewed with you so that you can make an informed decision about whether to undergo testing or not.
Will more than one visit be required?
The genetic counseling process usually requires two visits. The purpose of the first visit is to provide pre-test genetic counseling. If an individual decides they are interested in pursuing genetic testing, he/she can have blood drawn. The second visit is to receive test results. We require patients to return in person to discuss results.
How might I use the results of genetic counseling and testing?
The information provided may help to estimate a person’s risks for developing certain types of cancer, and to create an individual plan for screening and management based on those risks. This information may also be very useful for other family members.
I’ve already had cancer. Why should I get tested?
Genetic counseling and testing may provide information regarding risks to develop another cancer and options for screening and prevention. This process may also provide valuable information for loved ones.
Is genetic counseling the same thing as genetic testing?
No. Genetic counseling is a form of education and risk assessment. Individuals having genetic counseling learn about their specific risk factors based on reported information. Having genetic counseling does not mean that a person has to proceed with genetic testing. Many individuals who have genetic counseling do not have genetic testing. Genetic testing in a cancer setting involves specific analysis of blood to look for a constitutional gene change that is linked with an increased risk to develop cancer.
What is the difference between Oncotype DX™ testing and genetic testing?
Genetic tests look at an individual’s inherited traits or gene. Genomic tests look at a group of genes and how active they are. The Oncotype DX™ test looks at a panel of genes and their activity in breast tumor within the cancer itself. This activity can influence how likely breast cancer is to grow and respond to treatment. The Oncotype DX™ test does not provide information about an individual's inherited genetic makeup. It provides information about the genomic activity of the tumor.
May I bring someone with me to the genetic counseling appointment?
We encourage you to bring a support person. However, if some issues in your personal and medical history are very private, you may want to come alone.
I want genetic testing. Do I need to have the genetic counseling?
Yes. Genetic counseling by an experienced health care professional (ideally a certified or credentialed genetics professional) is an essential part of the genetic testing process and is critical for accurate result interpretation and management. During the genetic consultation, the risks, benefits, and limitations of genetic testing are discussed. The consultation also includes a discussion of medical management options for an individual and his/her family as well as information regarding issues such as the importance of confidentiality.
Will my insurance cover the cost of the genetic counseling visit?
Insurance coverage varies for genetic services. A genetic counseling consultation is generally billed as a specialty office visit. The majority of insurance companies cover the cost of the genetic counseling session, however every policy is different. Please check with your insurance carrier to see what type of coverage you have.
Will my insurance cover the cost of genetic testing?
There is not a way for Lifetime to preauthorize coverage for testing prior to your initial visit. The laboratory tests are performed by independent outside labs. During your initial visit, the genetic counselor will determine if you are eligible for genetic testing, which test(s) would be most appropriate, and whom in the family (ideally) should be tested first. The genetic counselor will discuss the cost of the testing with you (up to $3000), and at your request, will help you see if your insurance company will pay for testing.
How do I make an appointment?
To make a genetic counseling appointment, please call 813-745-6769.
Is there anything I need to do prior to my appointment?
Prior to a genetic counseling appointment, we ask that all patients please fill out a questionnaire. This questionnaire will ask questions regarding your personal medical history as well as your family history of cancer. This information will be used to provide a risk assessment regarding the likelihood of an inherited cancer risk in the family.
What about insurance discrimination, should I be concerned?
There are state and federal laws that protect against genetic discrimination. In May of 2008, the Genetic Information Nondiscrimination Act (GINA) law was passed. GINA provides individuals with additional insurance and employment protection. More information about this law is available at: http://www.genome.gov/24519851.
GINA covers individual and group health insurance and employment discrimination. It does NOT cover active military insurance and life/disability insurance, as well as other types of supplemental insurance.
Guidelines for Health Professionals
Indications for referral to assess cancer risk
- Two or more people, on the same side of the family, have the same type of cancer.
- Cancer diagnosed at age 50 or younger.
- Cancer in paired organs (e.g. both breasts, both eyes, etc)
- The presence of a very rare cancer (e.g. male breast cancer, medullary thyroid cancer, paraganglioma, retinoblastoma, or sarcoma.)
- A single person has more than one type of cancer (e.g. both colon and uterine cancer OR both breast and ovarian cancer).
- Cancer in two or more generations.
- Ethnic background (for example BRCA mutations are more common in those of Ashkenazi Jewish ancestry).
- A known cancer-predisposing genetic mutation in the family.
Why send patients to cancer genetic professionals?
They can provide:
- Extensive review of personal and family history to provide risk assessment for inherited cancer susceptibility.
- Expertise in rare genetic conditions.
- Familiarity with insurance coverage of genetic testing and alternative testing options for patients without insurance coverage.
- Appropriate medical management for patients with genetic cancer syndromes and/or strong family histories of cancer.
- Resources for patients including education, support, and research opportunities.
Referral information
To refer patients for consultations, please call 813-745-6769 or fax a referral to 813-745-5935
To obtain more information about cancer genetics or DNA testing, or for educational sessions for health care professionals, call 813-745-3555
What is Hereditary Cancer
Most cancer is sporadic, meaning it happens by chance. Although everyone has a chance of developing cancer, there are certain factors (e.g., lifestyle habits or family genetics) than can increase or decrease this chance. However, a small number of people (~10% of the population or less) inherit altered genes that may predispose them to developing particular cancers. Since the 1990s, several inherited cancer genes have been discovered, for which genetic testing is available. Individuals interested in learning more about whether they or their family members may be at a higher risk for cancer development due to an inherited gene should consult with a specialist with experience in the area of hereditary cancer, cancer risk assessment, and genetic counseling and testing.
If you are interested in learning more about hereditary cancer syndromes, please click here
For more information about hereditary cancer predisposition, we have provided the links below:
National Cancer Institute PDQ Cancer Information Summaries: Genetic
PQD is an online database developed and maintained by the National Cancer Institute which is designed to make the most current, credible, and accurate information available to health professionals and the public. Visit PDQ® Cancer Information Summaries: Genetics
National Cancer Center Network (NCCN) is an alliance of 21 of the world's leading cancer centers. They provide an authoritative source of comprehensive practice guidelines which are updated on a continual basis. To view these guidelines, visit NCCN Genetic/Familial High-Risk Assessment: Breast & Ovarian Guidelines
Who We Are
Tuya Pal, M.D., FABMG
Jennifer Brzosowicz, M.S., CGC
Deborah Cragun, M.S., CGC
Meghan Sherman, M.S.
Helpful Resources
Support:
Facing Our Risk of Cancer Empowered (FORCE)
An organization for individuals whose family histories and genetic status put them at high risk for breast and ovarian cancer, and for families in which a BRCA change may be present. To learn more about FORCE, visit
www.facingourrisk.org or call 1-866-824-7475.
Information:
National Cancer Institute PDQ Cancer Information Summaries: Genetic
PQD is an online database developed and maintained by the National Cancer Institute which is designed to make the most current, credible, and accurate information available to health professionals and the public. Visit
PDQ® Cancer Information Summaries: Genetics
Moffitt Cancer Prevention Center
The Cancer Prevention Center is an offsite clinic at Moffitt that provides the latest in cancer genetics research, screening technologies for breast, cervical, prostate, ovarian, and skin cancer, as well as preventative counseling. Through these services, Moffitt helps individuals understand and reduce their risk for developing cancer. To learn more about your risk for developing cancer, visit our website at www.lifetimecancerscreening.org or call CANCER ANSWERS at 1-888-MOFFITT
National Society of Genetic Counselors
The mission of the National Society of Genetic Counselors is to advance the various roles of genetic counselors in health care by fostering education, research, and public policy to ensure the availability of quality genetic services. To locate genetic counseling services close to you, visit http://www.nsgc.org/FindaGeneticCounselor/tabid/64/Default.aspx
Research and Outreach:
ICARE Inherited Cancer Registry
ICARE stands for
Inherited
Cancer
Registry. It is a registry developed for individuals interested in taking part in studies on inherited cancer. It represents a clinical-research-community partnership among medical practitioners, researchers and members of the general population. The registry is made up of individuals who are at high risk for developing hereditary cancer. To learn more about ICARE,
www.moffitt.org/ICARE
Breast Cancer Genetics Research and Education for African American Women Team (B-GREAT)
The "team" represents the academic-community partnership (consisting of community leaders and researchers) that was developed to address breast cancer health disparities in Black women. To learn more about the B-GREAT initiative, visit www.bgreatinitiative.com
Internship Opportunities
Melissa W. Bugbee Summer Internship for Genetic Counseling Students in Tampa, FL
The H. Lee Moffitt Cancer Center, the only NCI-designated comprehensive cancer center in the state of Florida, is pleased to announce the initiation of an exciting summer internship opportunity for genetic counseling students. The internship will incorporate clinical, research, education and outreach opportunities, available through our clinical service and existing research initiatives. Tampa is on Florida’s west coast and offers world class beaches and a multitude of theme parks in close proximity.
Goals and Objectives:
- To increase knowledge about hereditary cancer syndromes
- To gain competency in comprehensive cancer genetic counseling
- To develop an awareness of the psychosocial and support needs of cancer genetic counseling patients and to learn to be responsive to those needs
- To understand and appreciate the roles of inter-disciplinary team members in a cancer genetics setting
- To increase proficiency in oral and written communication about patient and professional topics in clinical cancer genetics
- To become familiar with and be given the opportunity to collaborate and assist with ongoing clinical research projects and community outreach opportunities
Criteria:
Genetic counseling Master’s degree students currently enrolled in accredited genetic counseling programs who have completed their first year requirements.
Program Description:
Students will fulfill clinical requirements at the Genetic Counseling and Testing Service at the Moffitt Cancer Center, housed at the Moffitt Cancer Prevention Center in Tampa, Florida. They will work under the supervision of two genetic counselors and one medical geneticist. Research and community outreach opportunities will be conducted under the co-supervision of the Medical Geneticist, Genetic Counselors and Research Faculty and Staff.
Logistics:
This is a full-time internship. Students are expected to spend 40 hours a week in clinic. There is flexibility with the start and end dates, but there is a minimum time commitment of 4-6 weeks. There will be two summer rotation opportunities, with the first student beginning mid-May and the second student beginning in early July. The Moffitt Cancer Center is located on the University of South Florida’s campus which offers summer intern housing opportunities.
Clinical Opportunities:
Students will participate in all aspects of case management and will be expected to gain skills in the following areas:
- Case preparation for patient sessions including review of medical records and literature
- Identifying appropriate genetic counseling referrals
- Contracting with patients
- Eliciting a medical and targeted family history
- Explaining genetic information at a level appropriate for the patient
- Communicating with patients in a culturally competent manner
- Identify services and support for patient
- Understanding issues related to billing and reimbursement for genetic testing
- Disclosing test results
- Comprehensive follow-up including written summary letters
- Effectively presenting cases
- Demonstrating initiative for professional growth
After an initial period of observation and co-counseling, students will be expected to complete cases in their entirety. The student may also have the opportunity to participate in the annual FORCE conference, a national support organization for those with inherited breast and ovarian cancer.
Educational Opportunities:
Students will attend weekly breast oncology and gynecological oncology tumor boards, genetic conferences, and lunch lectures. Additionally, the student will assist in presenting cases at a bi-monthly case conference that is webcast to locations across the state.
Research Opportunities:
Students will have the opportunity to assist with the Inherited Cancer Registry (ICARE) initiative. ICARE is a registry-based research study at the Moffitt Cancer Center and represents a clinical-research-community partnership among medical practitioners, researchers and members of the general population. The registry is made up of individuals who are at high risk for developing hereditary cancer. Students would be involved in assisting with participant recruitment and follow up, writing educational articles for participant newsletters, working with the ICARE database, and other ongoing projects.
www.moffitt.org/ICARE
Community Outreach Opportunities:
Students may have the opportunity to assist with the B-GREAT Program. B-GREAT is an acronym for Breast Cancer Genetics Research and Education for African American Women Team. The "team" represents a partnership consisting of community leaders and researchers that was developed to address breast cancer health disparities in Black women. This program seeks to educate and inform the African American community about the role inherited breast and ovarian cancer. Students would be involved with participant recruitment, education, and other ongoing projects. Students may also assist with preparation and delivery of presentations related to local outreach events related to the genetic counseling and testing service as well as ICARE.
www.bgreatinitiative.com
How to apply:
Students are asked to review the requirements for the internship, and submit the following by e-mail to Jennifer Brzosowicz, MS, CGC (Jennifer.brzosowicz@moffitt.org) by February 17, 2012: Curriculum Vitae, two letters of reference and a personal statement of 500-700 words outlining the following:
- Why you are interested in this internship opportunity at Moffitt Cancer Center
- What do you hope to gain from your experience if selected?
- What research fields interest you?
- What will make you a successful, dependable intern?
- Please indicate any special interests in cancer genetics, health disparities, and epidemiology.
- Please make a note your rotation preference (Mid-May through June or July through Mid-August.
Contact Us
Genetic Counseling and Testing Service at the Moffitt Cancer Center:
To schedule an appointment:
813-745-6769
For billing questions:
813-745-4848
For medical records requests:
813-745-4995
Click
here to download the release of medical records form to request us to send your records to a physician or another facility. For questions about screening, cancer risks, and other services, call Cancer Answers at 1- 888-MOFFITT (663-3488).
Directions
Moffitt Cancer Center / Cancer Prevention
4117 E. Fowler Avenue
Tampa, FL 33617
Note that Moffitt Cancer Prevention Center is located approximately 1 mile from the Moffitt Cancer Center and Research Institute.
From I-275:
Northbound on I-275, turn right (East) on Fowler Ave – Exit 51.
Southbound on I-275, turn left (East) on Fowler Ave – Exit 51.
Go approximately 2.4 miles until you come to the light at McKinley Drive / Spectrum Drive. After passing this traffic light, get into the right turn lane and make an immediate right into University Park Business Center. Take another right into the parking lot in front of the Moffitt Cancer Prevention Center . There are three brick buildings. Cancer Prevention Center is the middle building. There is parking in front of the building and on the sides.
From I-75:
Northbound on I-75, move into the right lane to exit on the Fowler Ave/Temple Terrace Exit (Exit 265). Stay in the left lane (Fowler West) and merge onto Fowler as you exit the ramp. Go approximately 3.4 miles, moving into the left lane. Make a left at the traffic light at McKinley/Spectrum and then continue until you reach the first break in the concrete median. At this break, make a U-turn and then an immediate right into the side entrance of the University Park Business Center (the red brick buildings at corner of McKinley and Fowler). The Moffitt Cancer Prevention Center is the middle building and the entrance and parking is on the side closest to Fowler Avenue.
Southbound on I-75, continue to the left where the road splits to I-275. Remain on I-75 until you reach the Fowler Ave Exit, which merges right onto Fowler. Go approximately 3.4 miles, moving into the left lane. Make a left at the traffic light at McKinley/Spectrum and then continue until you reach the first break in the concrete median. At this break, make a U-turn and then an immediate right into the side entrance of the University Park Business Center (the red brick buildings at corner of McKinley and Fowler). The Moffitt Cancer Prevention Center is the middle building and the entrance and parking is on the side closest to Fowler Avenue.