Home » FAQ 

FAQ: Hereditary Cancer Risk Counseling & Genetics

Why should I consider getting a cancer risk assessment with a genetic counselor?
People have different reasons for wanting to know their cancer risk. Common reasons are:
• Understand the risk of cancer/additional cancers for themselves, their children, or other family members
• Discover if inheritance played a role in the development of their cancer or a family member’s cancer
• Obtain information about cancer screening tests, such as mammography, breast MRI, or colonoscopy
• Make decisions about the use of chemoprevention (taking drugs to reduce the risks for cancer) or preventive surgery
• Learn about genetic (DNA) testing for cancer-predisposing genes that may clarify risks for future cancers in themselves and their family members
What happens at a cancer risk assessment appointment?

The Hereditary Cancer Risk Counseling Program is staffed by a board-certified genetic counselor. Genetic counselors are healthcare professionals trained to evaluate family histories in order to identify genetic risk factors. It is important for patients to attempt to answer the following questions about their family history prior to a cancer risk assessment: Who had cancer in the family? Where did the cancer start? How old was that person when he/she was diagnosed with cancer? Has anyone already had genetic testing? Has anyone had any pre-cancerous findings (such as precancerous colon polyps)? Have people had surgeries that may have reduced their risks for cancer (such as having the uterus or ovaries removed)?

At the initial appointment, which generally takes 1-2 hours, you will meet with the genetic counselor to completely review your family and medical histories. After identifying your primary concern, your discussion with the genetic counselor can include:
• General information about the genetic basis of cancer
• An estimation of your risks for specific cancers based on your age, family history, and other risk factors
• Evaluation of your family history by constructing a family tree (also known as a pedigree) and by using statistical models
• The possible role of genetics in your family’s cancer
• Emotional issues surrounding cancer and risk
• The availability, risks, benefits, and limitations of genetic testing
• Cancer screening tests and recommendations for screening frequency

In cases where genetic testing seems reasonable and is desired, you may pursue testing during your initial appointment or at a follow-up appointment. Genetic test results are typically discussed in person at a later visit. Remember, the decision to do genetic testing is always a personal choice.
I am not sure that I want genetic testing, so why should I come for a cancer risk assessment?
Genetic testing is not a requirement for genetic counseling. Cancer risk assessment is focused on determining whether an individual is at increased risk for cancer. After our evaluation, some individuals will find that their risk is not as high as they thought and choose not to undergo genetic testing. Others will realize they have a much higher risk for cancer than suspected. They can use their risk estimates to access, through their healthcare providers, available prevention and early detection methods. In addition, you will be able to share this information with family members so that they may seek appropriate cancer risk management.
May I bring someone with me?
We encourage you to bring a support person(s) with you. Many people find it very helpful to have an “extra set of ears” present during the initial appointment. Family members may also benefit from the information provided, and they may be able to help with providing family history information. However, if some issues in your medical history are highly private and not known to your relatives, you may want to come alone.
Will my insurance cover the cost of genetic counseling and testing?
Most insurances cover the cost to see a genetic counselor. Many people will need to pay a specialist copay. If you have concerns about whether or not your insurance will cover this appointment, please contact your insurance company directly.

Genetic testing is also covered all or in part by most insurance companies if genetic testing is considered medically necessary. Coverage and cost of genetic testing is discussed at your initial appointment with the genetic counselor. Most laboratories are able to give you an estimated out of pocket co-insurance and deductible quote prior to starting your test.
Can my health insurance company drop my coverage or raise my rates if they find out that I have a genetic predisposition to cancer?
On May 21, 2008, President George W. Bush signed the Genetic Information Non-Discrimination Act (GINA) of 2007-2008. GINA prevents health insurers from denying coverage, adjusting premiums on the basis of genetic information, or requesting that an individual undergo a genetic test. Previous federal and state laws (including HIPAA) provided protection, but this law provides more complete protection.

If your question wasn’t answered, please call 805-682-7300.