Ht. Lynch et al., GENETIC-COUNSELING IN AN EXTENDED ATTENUATED FAMILIAL ADENOMATOUS POLYPOSIS KINDRED, The American journal of gastroenterology, 91(3), 1996, pp. 455-459
Objectives: To provide DNA-based genetic counseling to family members
in the direct genetic lineage of a family fulfilling phenotypical crit
eria for the autosomal, dominantly inherited, attenuated familial aden
omatous polyp (AFAP) syndrome, This enabled highly targeted cancer ris
k estimation based on cancer phenotype in concert with the presence or
absence of the adenomatous polyposis coli (APC) germline mutation, Ma
nagement recommendations could then be fully responsive to this syndro
me's natural history, Methods: Detailed family history with pathology
verification of colonic polyps and cancer was performed on an extended
AFAP kindred, Endoscopic gastrointestinal examinations enabled detail
ed knowledge of the syndrome's upper and lower gastrointestinal tract
phenotype, Molecular genetic evaluation of DNA led to the identificati
on of the APC germline mutation which co-segregated with the phenotype
, Results: Forty-two members of this extended AFAP family underwent DN
A testing, wherein 27 were found to harbor the APC germline mutation,
thereby enabling precision in their genetic counseling, Anecdotal exam
ples of this counseling experience, with particular attention to psych
ological reactions, as well as concerns about such issues as insurance
and employer discrimination, have been described, Conclusions: When D
NA-based testing is offered to AFAP family members, genetic counselors
must compassionately consider patients' psychological concerns when p
roviding detailed risk status and available surveillance and managemen
t programs.