The Center for Cancer Genetics is a multidisciplinary team of oncologists, radiologists, surgeons and gastroenterologists that provide a service for cancer mutation, diagnoses and individualizes follow up and preventative services for mutation carriers.
The Clinic for Cancer Genetic Counseling operates at Hadassah Ein Kerem. The clinic was founded in 1995 and since then more than 4000 people have been seen there.
The Cancer Genetics Clinic sees patients who have been referred by oncologists, gynecologists, surgeons, gastroenterologists, nurses and community doctors, and men and women who come in on their own for counseling about breast, ovarian or uterine cancer, colorectal cancer, and other forms of cancer in their family. The team is headed by Prof. Yablonski-Peretz Tamar, director of the Sharett Oncology Institute, and Prof. Meiner Vardiella. Head of Center for Clinical Genetics, and includes oncologists, psychologists and genetic counselors.
The attending oncologists and other doctors, headed by Dr. Kaduri-Sonenfeld Luna, are available for discussions later on if necessary regarding a follow-up plan and optional courses of action. The available follow-up plans and treatment options are adapted to each individual according to their age, stage of life and personal history, and the patients.
It should be emphasized that the genetic counseling and genetic tests are conducted under the strictest confidence. Results are given only to the patient and to no one else. Israel’s Confidentiality of Genetic Information Law states that an employer has no right to demand genetic information. The results are not stored in the hospital’s database.
Heredity and cancer – What is a genetic tendency towards developing cancer?
Our genes determine our development and characteristics, such as eye color, height, and so on. When a cell becomes malignant, changes occur in several of the genes causing it to grow and divide uncontrollably. In most cases, these changes take place in the cancerous cell itself and are not transmitted from one generation to another, that is, they are not hereditary. Indeed, most cases of cancer are not hereditary.
In rare cases, there is a genetic mutation that involves cancer risk, and this is hereditary. The individual that carries such a mutation is at greater risk of developing cancer. Since the development of a tumor depends on the appearance of other genetic changes, not every carrier will automatically develop a tumor, but the risk of getting cancer is greater among carriers. Changes to different genes involve increased risk for various tumors. The descendants of carriers have a 50% chance of inheriting the damaged gene from their parents.
To date several genes relating to the development of cancer have been discovered. The most common of these are related to breast cancer, ovarian cancer, uterine cancer and colorectal cancer. Generally speaking, carriers are recommended to have special monitoring and carry out suitable preventive measures, the goal of which is to reduce the incidence of illness and death.
When should you suspect an inherited tendency towards cancer?
It is important to emphasize that most cases of cancer are not hereditary in nature. Nevertheless, in families where there have been several cases of cancer, or in cases where the disease occurred at a relatively young age, there is a greater chance that this is a hereditary cancer. One may suspect a hereditary form of the disease if the number of cancer patients in the family is high, or if the age at which the disease appeared is relatively young (for example, in cases of breast or colorectal cancer – below age 50), and if several tumors appear in the same individual, for example, bilateral breast cancer, or uterine and colorectal cancer. Sometimes, especially in smaller families, there aren’t many cancer patients in the family, but the cancer may still be hereditary.
What should I do if I am concerned about my family history?
For most people with a family history of cancer, the risk that there is a hereditary genetic component is not great. Nonetheless, even if the suspicion of a genetic component is not high, a history of cancer in the family slightly increases the chance of the disease occurring among other family members and at times, justifies greater monitoring, identification and prevention. We recommend updating and consulting with your family doctor about this.
We recommend clarifying the need for genetic counseling if your family history includes: several family members who were ill and/or the age at which they got sick was relatively young. For example:
- cases where several individuals in your family had breast cancer and/or ovarian cancer and/or colorectal cancer
- the age at which these tumors were diagnosed was below 50
- bilateral breast cancer in women; or ovarian cancer in the case of Ashkenazi women
Genetic Counseling at Hadassah Hospital
Cancer Genetics counseling is the genetic aspects of cancer. This counseling is given at Hadassah Hospital’s Oncogenetic Clinic by a staff composed of a geneticist, oncologist and a psychologist. By collecting complete information about cases of cancer in your family and analyzing the significance of your family history, the staff assesses the degree to which you may be at risk for the disease and the level to which a genetic-hereditary component may be suspected, and you can receive information about options for genetic testing. At the meeting the staff explains the significance of the test, and discusses the advantages and disadvantages of genetic clarifications.
During the counseling session the staff clarifies what the patient expects to achieve from the oncological counseling meeting and tries to attend to each person individually, according to their individual needs, test characteristics and consequences.
Genetic Testing – What is recommended and what is the process?
Genetic testing is performed on the genetic material – the DNA – produced from blood that is taken through a simple blood test. Sometimes the test also involves a pathology sample of a tumor. The genetic material is saved for future tests at the family’s request.
It is preferable to perform the test using a sample from a person who is sick in order to identify the genetic change that exists in the family. If a change is identified in the test performed on the sick family member then it is proposed that the test be performed on health family members. In cases where it isn’t possible to test the sick family member, it may be time to consider testing the healthy family member, or it may be possible to produce DNA from a tumor sample from the sick person.
Testing for common changes in certain population groups, or changes that characterize a particular family, are relatively simple to perform, are low cost, and in most cases are funded by the public healthcare funds and/or supplementary insurance coverage. If no changes are found in this test, or if common changes are not found and a seriously hereditary condition is suspected, we will sometimes recommend a full scan of the suspicious genes or other complex genetic tests. These tests are often complicated and expensive, and therefore we recommend that they be carried out only in cases where a genetic-hereditary condition is greatly suspected, and then we can recommend follow-up measures that can reduce mortality.
There are times that even though complex tests did not identify a genetic component this does not necessarily rule out its existence. This could be a case of a gene that hasn’t yet been identified. In these cases the family is referred for monitoring for early identification and prevention, according to the level of risk determined on the basis of the family history.
Oncogenetic Clinic for genetic high risk patients in Hadassah.
Monitoring for early diagnosis and/or prevention of cancerous tumors is proposed to patients on the basis of their family history and/or the results of genetic testing. In any event, the individual himself must consider the monitoring that is recommended.
Below are general recommendations for populations defined as being at high risk. As stated, these recommendations must be adjusted for each individual and each case:
An examination once every six months. Mammogram from age 35, or starting from 5 years younger than the youngest case of breast cancer diagnosed in your family. It is recommended that women consider an ultrasound and MRI in certain cases, such as if they carry mutations in the BRCA genes.
In the case of increased risk for colorectal cancer, we recommend a colonoscopy starting 5-10 years earlier than the youngest case of colorectal cancer diagnosed in the family. If a specific hereditary condition is discovered, such as HNPCC or FAP, the age at which recommended monitoring should begin is even younger.
We recommend periodic monitoring, including a doctor’s examination, vaginal ultrasound examination, and testing for markers in the blood for ovarian tumors. However, since these are not effective for early diagnosis of ovarian cancer, we recommend prophylactic removal of the ovaries in certain cases.
We recommend periodic monitoring, include a doctor’s examination and a vaginal ultrasound.
The Oncogenetic Clinic for follow up of carriers with high risk for breast cancer (BRCA1, BRCAL, PALBZ, HNECC, P53 and other rare genes) operates on Sundays at the Breast Unit. In "one shop shop" service by a multidisciplinary team.
Impact of Genetic Information on Medical Treatment
Sometimes the genetic conditions has an impact on treating the disease itself, although in most cases the genetic condition effects only the recommendations regarding early detection and reducing risk.
Operations to reduce risk – These are recommended in certain cases following full genetic counseling on the basis of clinical, pathological and genetic data. For example, a woman who has had breast cancer may make decisions for treatment based on by her genetic condition. Recommendations for prevention and treatment must take into account several factors, such as family history of cancer, type of tumor and its pathological characteristics, the age of the person when diagnosed with the disease, and the patient’s own preferences.
Removal of the ovaries is suggested to women around age 40 who carry mutations in the BRCA1 or BRCA2 genes. Preventive breast removal is also considered under certain circumstances. Partial removal of the colon is considered only in rare cases.
What are the advantages and disadvantages of genetic testing?
Genetic testing may help address the uncertainty in families that are known to be a greater risk for cancer based on family history. A positive result, that is a discovery of a genetic basis for the disease, may confirm that there is a greater risk for contracting cancer, but it also allows for beginning appropriate medical monitoring and/or preventive surgery. We hope that in the future, preventive drug treatment will also be a possibility. A negative result may enable families to reassess their risk for the disease in certain cases, and take appropriate measures for proper monitoring. The results of genetic testing of a particular individual also have significance for his family members and his children, and may be of special importance in the case of decisions regarding fertility and childbirth.
The staff is aware of the fact that there are those who prefer not to cope with the emotional burden of knowing about carriers, or they may prefer not to carry out the tests at certain stages of their lives.
It is important to note that the existence of information regarding genetic carriers may have legal significance in terms of life insurance and medical insurance.
The Oncogenetic Clinic at Hadassah has an oncology nurse, working in conjunction with the Israel Cancer Society, whose job includes:
- Coordinating clinic meetings
- Preliminary explanation about the significance of the test
- Preparing referrals for counseling meetings
- Emotional support and monitoring
- Coordinating between staff members and other professionals
- Designing and coordinating a follow-up plan together with the staff
- Education for early detection of the disease
The oncology nurse helps those who have been referred to the Clinic, both when making decisions and afterwards, when they have received the test results.
To make an appointment to the Oncogenetic Carrier Clinic, please call 02-6778255 or e-mail to [email protected].
To contact the Cancer Genetic Clinic and to make an appointment to genetic counseling, please call the Hadassah appointment center on 02-5844111.
Cancer Genes - Information