A cancer diagnosis can turn a family upside down. It raises numerous questions about what will happen to the patient physically, emotionally, and financially. Patients usually also want to know what this diagnosis could mean for their biological relatives.
Mary B. Daly, M.D., Ph.D., FACP
Fox Chase Cancer Center; Chair, National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology Panel for Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate
Hereditary cancer risk assessment is an expanding science that offers a growing ability to look into the future and take some control. According to the National Cancer Institute, up to 10% of all cancers may have genetic causes. This has big implications for prevention, early detection, and treatment.
The National Comprehensive Cancer Network® (NCCN) publishes widely utilized clinical practice guidelines based on the latest evidence and expert consensus in this rapidly advancing field. Earlier this year, NCCN published a new, free patient-focused resource funded by NCCN Foundation® to share the latest recommendations with patients and caregivers.
Cancer testing criteria
More and more people with cancer and their relatives want to know if they meet the criteria for testing for inherited cancer risk. The NCCN Guidelines for Patients®: Genetic Testing for Hereditary Breast, Ovarian, Pancreatic, and Prostate Cancers shares detailed information on who would benefit from genetic testing across a variety of scenarios. This includes recommendations for testing everyone with pancreatic cancer, along with any first-degree blood relatives. Similar recommendations are made for everyone diagnosed with ovarian cancer, plus any first- or second-degree blood relatives. For breast and prostate cancer, the decision to test is based on additional factors, including age, ancestry, and family history.
Strict testing criteria are necessary to make sure any test result can be followed up with concrete action. For instance, people who test positive for a cancer-causing variant in certain ovarian cancer susceptibility genes may want to talk to their doctor about having their ovaries and fallopian tubes surgically removed. For people with cancer-causing variants in certain breast cancer susceptibility genes, screening via breast MRI may be recommended in addition to mammograms. Risk-reducing mastectomy may also be an option to consider for those at high risk of developing hereditary breast cancer. People with variants that increase risk for prostate cancer may want to undergo regular screening, like measuring prostate-specific antigen levels.
The patient guide from NCCN features a chart with more details on each potentially cancer-causing genetic variation and any next steps that could be appropriate for lowering risk based on that variant. It also includes information on how genetic testing can help people who have been diagnosed with cancer and their providers make informed treatment decisions, such as whether platinum chemotherapy and PARP inhibitors would be helpful.
Expert recommendations
Ultimately, it’s crucial for any genetic testing to include a consultation with a healthcare professional trained in genetics who can recommend the best testing approach for any individual. These professionals can also help interpret the results and guide next steps. The NCCN Guidelines for Patients: Genetic Testing for Hereditary Breast, Ovarian, Pancreatic, and Prostate Cancer is one of more than 70 free books that put the latest evidence-based, expert consensus-driven recommendations into easy-to-understand terms for patients and caregivers. Visit NCCN.org/patientguidelines to view best practices for nearly every type of cancer, plus prevention, screening, and supportive care.
