High-risk clinics help those at genetic risk for hereditary cancers

Most cancer cases — 66 percent according to a recent article in the journal Science — occur when cells abnormally mutate during the normal process of cell division. These are random, unavoidable errors caused only by bad luck, according to the paper’s authors. Another 29 percent of cancer cases are caused by environmental factors — think smoking. The final 5 percent are inherited when a faulty gene is passed from generation to generation.

A program at MD Anderson focuses on helping members, or potential members, of this “5 percent” group.

“People who carry hereditary mutations do not necessarily get cancer, but their risk of developing the disease at some point during their lifetime is higher than average,” says Karen Lu, M.D., co-medical director of MD Anderson’s Clinical Cancer Genetics Program and a professor of Gynecologic Oncology.

The program, one of the largest of its kind in the nation, is home to genetic counselors, physicians and others who work together to provide hereditary cancer risk assessment, genetic counseling and testing, and cancer screenings for patients and their relatives who are concerned about their personal and family history of cancer.

“We help people with a family history of cancer understand their risk,” Lu says, “so they can make informed medical decisions about their health.”

Certain factors make it more likely that cancers in a family are caused by an inherited gene, says Banu Arun, M.D., co-medical director of the program and professor of Breast Medical Oncology.

“Red flags should be raised,” she says, “if cancer occurs over several generations, like in a grandmother, mother and daughter; or if it’s diagnosed at a younger age than usual, like breast cancer in a 25-year-old; or if a family experiences multiple cases of the same types of cancer.”

Doctors may encourage these people to get tested, she says.

Patients and family members who are found to be at risk for hereditary cancers are referred to one of MD Anderson’s high-risk surveillance clinics for assessment of their personal and family history. The clinics offer genetic counseling and testing, personalized screening, long-term surveillance, and other interventions such as chemoprevention drugs to keep cancer at bay and prophylactic surgery to remove at-risk tissue or organs from the body before cancer occurs.

“Over the last two decades, great progress has been made in identifying the genes that predispose people to certain cancers,” says Y. Nancy You, M.D., the program’s associate medical director and an associate professor of Surgical Oncology. “With genetic counseling, testing and cancer prevention strategies, we can prevent cancer from occurring, or catch it in its earliest stage when it is most treatable.”

MD Anderson's high-risk clinics

• Breast Cancer High Risk Screening and Genetics Clinic
• Gynecologic Cancer Genetics Clinic
• High-Risk Ovarian Cancer Screening Clinic
• Familial High-Risk Gastrointestinal Cancer Clinic
• Endocrine Center
• Hereditary Genitourinary Malignancies Clinic
• Hereditary Hematologic Malignancy Clinic

A few hereditary cancer syndromes

• Hereditary Breast and Ovarian Cancer Syndrome
• Cowden Syndrome
• Hereditary Non-polyposis Colorectal Cancer Syndrome (Lynch Syndrome)
• Hereditary Leukemia and Hematologic Malignancies Syndromes
• Familial Adenomatous Polyposis (FAP)
• Li-Fraumeni Syndrome
• Von Hippel-Lindau Disease
• Multiple Endocrine Neoplasias