The Cancer Genetics Program at Newton-Wellesley Hospital

Hereditary Risk of Cancer
What determines the color of your eyes and your height? The genes you inherit from your mother and father influence these and other personal characteristics. Medical research has revealed that families also pass along tendencies to develop certain health conditions.

Some cancers have been found to have a significant hereditary link. About five to ten percent of gastrointestinal cancers (colon, pancreas and stomach), melanoma (skin) cancer and breast and ovarian cancers are correlated to genetic factors that are passed on from one generation to the next. Information about your family’s health history can help you make decisions about ways to prevent certain conditions or, in the case of cancer, begin screening tests for the purpose of early detection. In the case of most cancers, early detection increases the likelihood of more effective treatment and survival.

The Program
The Cancer Genetics Program at Newton-Wellesley Hospital provides services to individuals and families who are concerned about their cancer risks due to a personal or family history of cancer.

“Our program provides genetic counseling and genetic testing as well as follow-up care to discuss ways to lower and manage cancer risk,” says Taryn Rourke, Licensed Genetic Counselor for the Program. “These services are available to patients who have either a known hereditary cancer syndrome or a strong personal or family history of cancer.”

The Genetics Program team consists of a genetic counselor, nurse practitioners and medical oncologists. Depending on the patient’s personal and family history, the team may also refer the patient to an appropriate specialist for further management. These specialists may include gastroenterologists, gynecologists, surgeons and dermatologists.

A patient’s initial appointment consists of an individualized meeting with a genetic counselor to review medical and family history. The counselor will discuss the chance that the cancer in the patient’s family is hereditary. When appropriate, genetic testing will be offered.

Genetic Testing
“Genetic testing is performed on a blood or saliva sample provided by the patient to look for mutations in specific genes,” says Taryn. “Mutations are changes in the gene that cause the gene to malfunction and therefore increase a person’s risk of certain cancers. It is necessary for a patient to first have genetic counseling before undergoing genetic testing as counseling and testing work hand-in-hand.”

Prior to testing, Taryn analyzes a patient’s family history to determine which genetic tests are appropriate. “I always discuss the potential outcomes and implications of testing for both the patient and his or her family,” she adds. “I then review the risk, benefits and limitations of the specific genetic tests so that the patient is well informed before proceeding.”

Once the team has collected the patient’s history and test results, they discuss ways to manage and lower cancer including creating an individualized prevention and screening plan.

“If a genetic test shows that an individual has an increased risk for developing certain cancers, our team will discuss ways we can detect cancer at an earlier stage or lower the risk of cancer,” says Taryn. “This usually consists of more intensified screenings at a younger age. It may also consist of risk-reducing medicines and, in some cases, discussing surgical options. The individual would be followed by a high-risk nurse practitioner or medical oncologist who could order these screenings and provide ongoing follow-up care.”

When to See the Team
We recommend you be seen by the team at the Cancer Genetics Program if:

  • You or a close family member were diagnosed with cancer before age 50.
  • There are multiple individuals in your family with the same type of cancer or with related cancers (i.e. breast and ovarian cancer on the same side of the family).
  • There are rare types of cancer within the family (i.e. male breast cancer).
  • You or a close family member has had more than one cancer (i.e. bilateral breast cancer or an individual who has had both colon and uterine cancers).
  • There is a known inherited cancer syndrome in your family.

Newton-Wellesley also has a unique program in place that offers hereditary cancer risk assessment to all mammography and colonoscopy patients that come to the Hospital.

“All of these patients are asked about family history of cancer at the time of their appointment,” says Dana Dowd, RN, WHNP-BC, Nurse Practitioner at the Auerbach Breast Center. “All of these patients are asked about family history “If the family history suggests a hereditary pattern, the patient is referred to a genetic counselor. Most hospitals ask patients about family history of cancer, but Newton-Wellesley is one of the few hospitals in the country that can analyze this information, inform patients of their risk and refer them to appropriate resources.”

Computer Program
The Breast Center has a computer program that helps collect information about family history and estimates the risk of carrying a genetic mutation. Patients are able to enter their information on a computer tablet to capture data about their possible cancer risk. “This program allows us to screen thousands of Newton- Wellesley patients for hereditary cancer risk each year, which we would not be able to do without this technology,” adds Dana.

High Risk Clinic
The Breast Center also has a High Risk Clinic, which allows patients to be followed more closely and receive more information about how to reduce their risk of breast cancer. High risk patients are also counseled about lifestyle factors that may lower their risk for certain cancers. “Patients who have an increased risk for hereditary cancer have many options for either lowering their risk of cancer or screening more carefully,” explains Dana. “For example, patients who have an increased risk for breast cancer may start mammography screening at an earlier age or add breast MRI to their screening plan.”

A family history of breast and/or ovarian cancer is one of the major risk factors for developing these diseases. About 10 percent of breast and ovarian cancer cases are hereditary. “Two of the more common hereditary cancer syndromes we see are hereditary breast and ovarian cancer and also hereditary colorectal cancer syndromes,” says Taryn. “However, there are hereditary cancer syndromes for melanoma, thyroid, kidney, neuroendocrine and other cancers.”

Taryn recommends that patients talk with their families about health history and create a record to help understand what risk factors might be present. “If you feel you may be a risk, talk with your primary care physician to see if genetic counseling might be appropriate,” says Taryn. “We want patients to be educated about their cancer risks so we can take preventative action and help them plan for the future.”

Hereditary Risk Factors
Women with the following may be at risk for hereditary breast or ovarian cancer:

  • Two or more relatives with breast or ovarian cancer
  • A relative with premenopausal breast cancer
  • Ashkenazi Jewish ancestry
  • A relative with bilateral breast cancer
  • A relative with both breast and ovarian cancer
  • A relative with male breast cancer
  • Personal history of young breast cancer, bilateral breast cancer or ovarian cancer at any age Men and women with the following may be at risk for hereditary colon cancer:
  • Young diagnoses of colon or uterine cancer
  • Multiple individuals in a family with colon or related cancers (stomach, small bowel, uterine, ovarian, urinary tract,pancreatic)
  • Individuals who have had more then one colon cancer or with two related cancers (i.e. colon and uterine cancer)
  • Individuals with 10 or more colon polyps

More Information
For more information about the Cancer Genetics Program at Newton-Wellesley Hospital, please call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org/genetics.

Dana Dowd, RN, WHNP-BC, Nurse Practitioner
Auerbach Breast Center, Newton-Wellesley Hospital
Dana is a certified women’s health nurse practitioner. She received her bachelor of arts degree in psychology from Brandeis University and her master’s of science in nursing from Boston College.

Taryn Rourke, MS, LGC Licensed Genetic Counselor
Vernon Cancer Center, Newton-Wellesley Hospital
Taryn is a licensed genetics counselor certified by the American Board of Genetic Counseling. She received her master’s of science in human genetics from Sarah Lawrence College. Taryn is a member of the National Society of Genetic Counselors.

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