Patients at high risk for familial cancer, history of cancer at a young age, or history of multiple cancer occurrences may be referred to genetic counseling for genetic testing from the primary care office, which makes internists an important partner with genetic counseling.
In a commentary published in Annals of Internal Medicine, experts from the Sidney Kimmel Cancer Center at Thomas Jefferson University, Dana-Farber Cancer Institute, and Memorial Sloan Kettering Cancer Center explain three main areas in oncology where genetic evaluation is changing care for patients, and how close collaboration between internists and cancer genetic specialists is crucial.
Genetic testing in oncology has expanded rapidly in recent years to encompass testing multiple genes at a time for inherited cancer risk, evaluating tumor molecular signatures for cancer risk, and testing multiple genes in tumor specimens to inform treatment. Genetic counseling is critical for helping patients understand the implications of findings from these various genetic testing strategies and how they may affect the patient and his or her family.
Because internists are privy to a patient's total health history, including cancer risk, they are in a unique position to identify patients that may benefit from genetic counseling. This is important because referral for genetic consultation and identification of an inherited gene mutation in a patient can dramatically impact cancer screening approaches and provide options for cancer prevention. Close collaboration between internists, oncologists, and cancer genetic specialists is also important in precision medicine efforts that stem from genetic testing of tumors for treatment. Once a genetic mutation is identified in their patients, internists should discuss referral of family members for genetic counseling for cascade testing, or testing among other family members to determine if they carry the familial mutation.
Explore further: Genetic counseling helps determine risk for hereditary cancers
Annals of Internal Medicine (2017). http://annals.org/aim/article/doi/10.7326/M17-2512