Q. Who Can Benefit from a Hereditary Cancer Risk Assessment?
A. Anyone with a personal and/or family history of:
- More than one diagnosis of cancer in the same individual
- Breast cancer diagnosed before age 50
- Bilateral breast cancer (cancer in both breasts)
- Breast cancer at any age with one of the following:
- Ashkenazi Jewish ancestry
- At least one other family member with breast cancer diagnosed before age 50
- Two or more other family members (from the same side of the family) with breast cancer at any age
- At least one other family member with ovarian, fallopian tube, or peritoneal cancer diagnosed at any age
- Two or more other family members (from the same side of the family) with breast and/or pancreatic cancer
- A personal or family history of thyroid cancer, sarcoma, adrenocortical cancer, endometrial cancer, pancreatic cancer, brain tumors, gastric (i.e. stomach) cancer, early onset leukemia
- Breast cancer in a man
- Ovarian, fallopian tube, or peritoneal cancer at any age
- Colon or rectal cancer diagnosed before age 50
- Colon or rectal cancer diagnosed at any age with one of the following:
- At least one other family member with colon or rectal cancer diagnosed before age 50
- At least one other family member with endometrial cancer before age 50
- Two or more other family members (from the same side of the family) with colon, rectal, endometrial, stomach, small bowel, renal-pelvis, or urethral cancer at any age
- Greater than 10 colon or rectal polyps
- Endometrial cancer diagnosed before age 50
- Renal cancer before age 50
- Renal cancer at any age with at least one other family member with renal cancer
- Two or more family members (from the same side of the family) with pancreatic cancer
- Multiple family members (from the same side of the family) with cancer, especially if diagnosed before age 50
- A personal or family history of a known hereditary cancer syndrome or altered cancer-predisposing gene
Q. What will happen during my visit?
A. You will meet with Dr. Clair Francomano and genetic counselor, Christy Haakonsen. We will review your medical and family history and a brief physical exam will be performed to look for any possible physical features of certain hereditary cancer conditions. Based on this information, we will assess the likelihood of an underlying hereditary cancer condition and provide you with a personal risk assessment. We will then discuss any appropriate genetic testing along with the benefits, risks, and limitations of genetic testing. In addition, we may discuss cancer screening recommendations and ways or options to decrease cancer risk. If genetic testing is pursued, we will facilitate ordering the appropriate testing which can usually be coordinated the same day as your initial visit.
Q. How long does a typical visit last?
A. The average initial visit lasts about one hour.
Q. How long does it take to get an appointment?
A. Our appointment wait times vary but on average our next available non-emergent appointment is 3-4 weeks. However, we will make every effort to accommodate earlier appointments if our assessment affects treatment decisions. If this situation applies to you, please mention this to us so that we can provide you with an emergent appointment time.
Q. Can I have genetic testing without genetic counseling?
A. We do not offer genetic testing without genetic counseling. Reviewing your medical and family history along with the physical exam is an important part of the risk assessment and testing process and is essential to ensuring the most appropriate test is ordered. In addition, it is important for us to discuss the benefits, risks, and limitations of genetic testing for accurate result interpretation and medical management.
Q. What information do I need for my appointment?
A. We ask all our patients to complete a pre-visit questionnaire, which will ask questions about your medical and family history. By completing this questionnaire before your appointment, it allows you to speak with family members to obtain accurate cancer family history. In addition, if another family has already had genetic testing, it will be helpful to have copies of this family member's genetic test results prior to your appointment.
Q. How long does it take to get genetic test results back?
A. This depends on the specific test being ordered. Some genetic test results come back as soon as 1-2 weeks and other tests may take 2-3 months. In addition, if your insurance requires prior authorization before starting testing, this will add time to the testing process.
Q. Will my insurance cover the cost of genetic testing?
A. Fees for genetic testing are separate from the office visit fees. In general, insurance coverage for genetic testing is very good. However, coverage for genetic testing is based on your designated insurance health plan benefits and policies. Once we determine what type of testing would be appropriate, our genetic counselor will be able to provide you with additional information regarding insurance coverage at the time of your visit.
Q. Will my insurance cover the cost of the hereditary cancer risk assessment?
A. As a medical practice of the Greater Baltimore Medical Center, we accept all health insurances with which GBMC maintains contracts and complies with all GBMC financial policies. Our administrative staff will be happy to assist you in determining if your health insurance maintains a contract with GBMC.
Most health insurances cover outpatient genetics consultations as well as many forms of genetic testing. If you are required to pay a co-payment, co-payments are at the specialist rate. If your insurance requires a referral, it is your responsibility to obtain this prior to your appointment. Inpatient genetics consults are covered under the terms of the patient's hospitalization insurance.
Q. Can my employer or health insurance use my genetic test results against me?
A. In 2008 a federal law known as the Genetic Information Nondiscrimination Act (GINA) was passed to prohibit discrimination based on genetic information with respect to health insurance and employment. For more information see: http://www.dnapolicy.org/gina
Q. What if I have other questions?
A. Our administrative staff or our genetic counselor would be happy to help answer any other questions that you might have. Please contact us at 443-849-3131.