By reporting on the possible existence of a hereditary cancer and reco
mmending further genetic evaluation, the pathologist can help identify
families with hereditary cancer. Currently, however, recognition of a
case of hereditary cancer relies predominantly on clinical criteria,
as common cancers show only a few specific pathologic features that su
ggest hereditary predisposition. Furthermore, clinical criteria alone
often fail to identify mutant gene carriers. In contrast to genes that
have a high penetrance for causing cancer, such as BRCA1, APC, RET, a
nd the mismatch repair genes, identifying carriers of mutant genes hav
ing a lower penetrance (as is the case for the BRCA2 gene) is more dif
ficult. Studies to identify markers for mutant germline cancer-predisp
osing genes will typically require studying archival tissue specimens,
but germline genetic testing on archival samples for research purpose
s is complicated by the need for patient consent unless specimens are
stripped of their patient identifiers. Pathologists contemplating such
research should seek informed consent for genetic testing prior to ar
chiving tissues. The need for consent has led to concerns that certain
types of cancer research projects will no longer be feasible; if pati
ent consent has not been obtained, however, institutional review board
-approved protocols that facilitate obtaining patient clinical data wh
ile maintaining patient confidentiality can overcome this problem. As
clinical genetic testing for hereditary cancer becomes part of clinica
l practice, there are many concerns about the quality of service at ea
ch step in the process, One of the most important requirements for qua
lity is to ensure that the performance of a generic test is always lin
ked to adequate pretest and posttest genetic counseling. Reporting of
genetic test results should be standardized and include information ab
out the technique used to identify mutations, the sensitivity and spec
ificity of the test in detecting such mutations, and the limitations o
f the test. The report should also contain recommendations for further
action and information packets to assist in the interpretation of the
test. Pathologists have expertise in the area of laboratory proficien
cy testing and can play an important role in the establishment of a na
tional proficiency program to ensure a quality genetic testing process
. (C) 1997 American Cancer Society.