CANCER RISK ASSESSMENT IN A HEREDITARY CANCER PREVENTION CLINIC AND ITS FIRST-YEAR EXPERIENCE

BACKGROUND. Hereditary cancer accounts for 5-10% of the estimated 1.38 million cancer cases in 1997 and requires an approach to cancer preve ntion that is distinct from its sporadic counterpart based on its diff ering natural history. The laboratory advances in the molecular biolog y of hereditary cancer have recently resulted in the development of sp ecialized hereditary cancer clinics with both broad and syndrome speci fic hereditary cancer assessment capabilities. A key question is how w ell these clinics can accomplish this new mission. METHODS. A total of 58 people underwent hereditary cancer risk assessment in the Creighto n University Hereditary Cancer Prevention Clinic from September of 199 5 to September of 1996. Assessment included construction of a detailed pedigree and a cancer-directed medical history and physical examinati on. Cancer education, genetic counseling, the option of DNA resting wh en appropriate, and cancer prevention recommendations based on cancer risk were provided. RESULTS. The 58 patients were comprised of 51 fema les (88%) and 7 males (12%) predominantly from the Omaha, Nebraska geo graphic region. Forty patients (69%) were cancer unaffected whereas 18 (31%) were cancer affected; patient age ranged from 6 to 70 years wit h a mean age of 40 years. Thirty (52%) of the patient families were di agnosed with a hereditary cancer syndrome, 24 (41%) were diagnosed wit h familial cancer risk, and 4 (7%) were diagnosed with sporadic cancer risk. Of the 30 families with hereditary cancer syndromes, only 4 (13 %) individuals have so far undergone DNA testing due to a variety of e motional, financial, insurance, and technical barriers. CONCLUSIONS. T he authors have successfully implemented a clinically applicable hered itary cancer prevention program based on their expertise in hereditary cancer risk assessment that offers DNA testing through. a commercial laboratory to patients diagnosed with hereditary cancer syndromes. How ever, a number of barriers to DNA evaluations exist that will require discussion among the medical, legislative, insurance, and lay communit ies in addition to further research in hereditary cancer risk assessme nt, genetic counseling, and cancer prevention strategies. (C) 1997 Ame rican Cancer Society.