Cancer genetic counseling is meeting with a genetic counselor to review your risk for cancer. We help identify patterns in your family and personal health history that may signal you have an inherited cancer syndrome. These kinds of disorders can increase your risk of certain cancers.

Meeting with a cancer genetic counselor is the first step before genetic testing. After your first meeting, they may order genetic testing. You’ll speak with them again later to review the results and discuss what they mean for you.

Not everyone is ready to learn the results of genetic testing. We understand these results can feel overwhelming and confusing. So a genetic counseling appointment doesn't automatically mean that you’ll do a genetic test.  

Our genetic counselors provide compassionate care, helping you decide whether testing is right for you. When your results are in, they can provide a seamless transition to a care team that can provide options with your goals in mind.

Sometimes, what we find during genetic counseling and testing can benefit other family members. We can help you have these conversations.

Genetic testing requires a sample of DNA (usually obtained in blood or saliva) and looks for mutations that can increase your risk of certain cancers. We call this genetic testing for inherited cancer risk.

Sometimes, cancer seems to run in families, but there’s no known genetic mutation that causes it. Instead, family members may share things that increase their cancer risk, such as diet, smoking, or where they live. 

The only way to know if you have a harmful genetic mutation is to get genetic testing.

Inherited cancer risk vs. tumor testing

Genetic testing for inherited cancer risk is not the same as the testing done on tumors after cancer is diagnosed.

Tumor genetic testing looks for genetic changes that happened in your lifetime. These are the changes that lead to cancer and impact tumor growth and treatment. We also call this tumor DNA sequencing, somatic testing, or biomarker testing. We do this testing using a sample of your cancer.

Genetic testing for inherited genetic changes is typically a blood test or saliva collection. We test for gene changes you got from your parents that studies have linked to a higher risk of cancer.

If you have cancer, this information can help guide your treatment. It’s also helpful in deciding whether to take preventative measures or have additional cancer screening tests.

Types of genetic testing

If someone in your family has a genetic cancer syndrome, our genetic testing can see if you have that specific change.

If you have a family history of cancer, we'll test for genetic changes across multiple genes at the same time. This is a multigene test or a panel test. A broad panel test looks at genes linked to several common cancers. Changes in these genes may increase your risk of getting these cancers.

Our genetic counselors work with you to decide how much information you need or want.

Cancer genetic counseling is right for you if you’re in one of these situations:

• Your personal or family medical history shows you may be at a higher risk of cancer
• You have a direct family member who has an inherited cancer syndrome
• You have a cancer that suggests an inherited cancer syndrome

The National Cancer Institute recommends genetic testing for anyone with certain cancers. These cancers are more likely to occur when someone has a genetic cancer syndrome.

They include, but are not limited to:

• Triple-negative breast cancer
• Ovarian cancer
• Pancreatic cancer
• Colorectal cancer before age 50
• Endometrial cancer before age 50
• Metastatic or high-risk (with a Gleason score of 7 or higher) prostate cancer
• Male breast cancer

Genetic testing provides vital information to guide treatment. Knowing this information will also help other family members learn about their risk of these cancers.

You may want to consider cancer genetic counseling and testing with any of these signs of inherited cancer syndrome:

• Parent or sibling or other close relative diagnosed with a genetic cancer syndrome
• Many family members with the same type of cancer, especially if it follows a pattern, such as parents, children, and siblings
• You or a family member have had cancer at a younger than usual age
• You or a family member have had bilateral disease, such as cancer in both breasts or both kidneys
• You or a family member have had a rare type of cancer, such as male breast cancer
• You or a family member have had several different types of cancer
• You're a member of a racial or ethnic group that has a higher risk of certain cancers

When you come to Carilion for cancer genetic counseling, you'll have a cancer risk assessment tailored to you.

Before visiting a genetic counselor, you'll complete a questionnaire about your personal and family medical history. 

During the consultation, we will:

• Review your personal medical information and 3-generation family history
• Estimate your overall cancer risk
• Determine the chance that your family may have an inherited risk of cancer
• Discuss whether you would benefit from genetic testing

Depending on what your cancer genetic counselor finds, they may suggest genetic testing that same day. 

Depending on your personal and family history as well as your preference, your care team may order tests that focus on one type of cancer, or they may order a broad test.

To run a genetic test, we may take samples of:

• Blood 
• Saliva 
• Cheek or skin cells

After we collect the samples, we send them to a genetic testing laboratory. It most often takes about 2 – 3 weeks to get your results.

When the results are in, our cancer genetic counselor will review them with you. We can help guide you on the next steps. 

If you have a genetic mutation that increases cancer risk, you’ll join our high-risk cancer screening program. We’ll also discuss your options for preventing cancer.

How does testing help prevent cancer?

Genetic testing can help us tailor strategies that may reduce your risk of cancer or help us catch cancer early. 

They can include:

• Starting cancer screenings earlier
• Doing screenings more often or using different tools from usual
• Using cancer prevention drugs
• Performing risk-reducing procedures

Most cancer happens by chance. Genetic makeup, lifestyle, and environmental factors can all play a role in why someone develops cancer. Only 5 – 10% of cancers are due to an inherited genetic mutation.

Having an inherited genetic mutation doesn't mean you'll get cancer. For some people, just knowing you have the mutation can lead to anxiety about developing cancer and overtreatment, which is why not everyone chooses to do genetic testing.

Many major insurance carriers cover a cancer genetic consultation visit. If needed, your referring physician can get authorization. 

Your genetic counselor can work with your insurance carrier to determine if your plan covers genetic testing. Most cover genetic testing for people at high risk for certain cancers.