Clinician-to-Clinician Update Clinician-to-Clinician Update

Early Cancer Detection and Prevention for At-Risk Individuals

November 2014

People with a personal or family history of cancer may not be aware that there could be a genetic component to their cancer risk, especially those with a family history of breast, ovarian, colorectal, or endometrial cancer, or those who have two or more close relatives with certain cancers. In addition, those with history of certain non-cancer diseases, such as ulcerative colitis, or those who have been exposed to radiation, are also at increased risk of developing particular types of cancer. Launched this year, our Cancer Risk Management Program was created just for these types of individuals. As part of University of Minnesota Cancer Care, the program is designed to help patients evaluate their risk of developing cancer and to work with them and their referring healthcare providers to manage cancer risk over the long term.

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According to the most recent guidelines from the American Society of Clinical Oncology1, a comprehensive cancer risk assessment includes clinical assessment, genetic testing when appropriate, and risk management recommendations. These services should be delivered in the context of one or more counseling sessions with a genetic counselor. Indeed, published evidence indicates that knowledge of genetics and genomics remains limited across all health-care disciplines, with the exception of genetic specialists.2 That is why the experts in the Cancer Risk Management Program include a clinical nurse specialist, genetic counselors, and cancer physicians. Our team members have extensive knowledge about hereditary cancer syndromes, risk-appropriate management strategies, patient and family counseling services, and genetic nondiscrimination laws, all areas that have been identified as weaknesses in the majority of healthcare disciplines.3,4,5 To increase convenience for patients, appointments can be made with our practitioners at eight locations.

After conducting individualized cancer risk assessments, our clinicians work together with each other, the patient, and with the referring physician to design personalized cancer screening and prevention plans. We provide ongoing risk-monitoring care, which includes annual appointments for all of our patients. The program’s medical director, Robert Madoff, MD, notes that with rapidly evolving genetic testing options, surveillance guidelines, and recommendations for prophylactic procedures, it is critical that patients who may have an elevated risk for cancer be carefully monitored by a dedicated care team that is committed to working with them in the long term. In addition, the Cancer Risk Management Program can help whole families by encouraging patients to reach out to other family members, share information, and possibly be seen to evaluate their own risk.

References

1. Robson ME, Storm CD, Weitzel J, et al. American Society of Clinical Oncology policy statement update: genetic and genomic testing for cancer susceptibility. J Clin Oncol. 2010;28(5):893-901.

2. Harvey EK, Fogel CE, Peyrot M, et al. Providers’ knowledge of genetics: A survey of 5915 individuals and families with genetic conditions. Genet Med. 2007;9(5):259-67.

3. Wideroff L, Vadaparampil ST, Greene MH, et al. Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians. J Med Genet. 2005;42 (10):749-55.

4. Pal T, Cragun D, Lewis C, et al. A statewide survey of practitioners to assess knowledge and clinical practices regarding hereditary breast and ovarian cancer. Genet Test Mol Biomarkers. 2013:17(5):367-75.

5. Laedtke AL, O’Neill SM, Rubinstein WS, et al. Family physicians’ awareness and knowledge of the Genetic Information Non-Discrimination Act (GINA). J Genet Couns. 2012;21(2):345-52.

When to Refer

A referral to the Cancer Risk Management Program is indicated for the following types of patients*:

  • Patients with personal medical histories such as multiple different cancers, breast or colon cancer before age 50 and others.
  • Patients with a history of multiple family members with the same or related cancers, including breast, colon, ovarian and others.
  • Patients with certain non-genetic risk factors, such as ulcerative colitis.
  • Patients with hereditary cancer syndromes, including Lynch syndrome, BRCA1 or BRCA2 mutations and others.

If you have questions regarding a referral, please call Kristin Baker Niendorf, MS, CGC/Cancer Risk Management Program Director, (612-624-7797) or Denise Musser, ACNS-BC/Clinical Nurse Specialist (612-626-9898).

Collaborative Care

The Cancer Risk Management Team is committed to ongoing collaboration with primary healthcare providers, from the time of the initial appointment with your patient through life-long cancer screening and follow-up care, when indicated. Our program team follows established National Comprehensive Cancer Network (NCCN) protocols for cancer screening, all of which are shared with primary providers, and we work with primary providers to establish an appropriate care routine with their patients.

For patients who require long-term screening studies, our program can monitor the time intervals for testing and remind patients and their primary providers of the need for testing. Conveniently, screening tests and examinations can occur at any facility that the patient and provider choose and can still be tracked by our program. The Cancer Risk Management Program is committed to whole-life care, making the ongoing process of cancer screening as easy as possible for patients and their primary healthcare providers.

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