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Hereditary Cancer

Hereditary cancer happens when a gene mutation that increases cancer risk is passed down from a parent to a child.
Being born with that gene mutation means that a person has a higher chance to develop specific types of cancer, and those cancers may happen at younger than average ages.

Hereditary Cancer Program

The Hereditary Cancer Program provides genetic counselling and genetic testing for BC/Yukon residents who may have inherited an increased risk for specific types of cancer. Similar services are available across Canada and in other countries.
 
Use the tabs below to find information about hereditary cancer, genetic testing and genetic counselling.


Common Questions
This section provides answers to some common questions about hereditary cancer and the Hereditary Cancer Program. For more information, click "+" on the questions below.

All cancer is caused by gene changes building up inside a cell. Those changes (gene mutations) happen in several ways. Some gene mutations are caused by factors outside the body (exposures), some happen during normal cell division, and we are born with some gene mutations. When gene mutations interfere with normal cell growth, that cell starts to grow without its usual controls and becomes a cancer. This happens more often in older people, so the risk for most cancers increases with age.
Hereditary cancer happens when a gene mutation that increases cancer risk is passed down from a parent to a child. Being born with that gene mutation means that a person has a higher chance to develop specific types of cancer, and may have cancer at a younger than average age. Families with hereditary cancer are more likely to have: 

  • Several people with the same type(s) of cancer 
  • Cancer in relatives over more than one generation (e.g. grandparents and parents)
  • Cancer that starts at earlier ages than is common for that type of cancer (e.g. breast cancer or colon cancer before age 50)
  • People with more than one cancer diagnosis
  • People with less common cancers

Hereditary cancer is not common. Less than 10% of all cancer is hereditary. That means that less than 1 of every 10 cancers is caused by a gene mutation that is passed down in a family.

 
Cancer is very common. That means most people will have some relatives with cancer, especially in a big family. Age is the biggest risk factor for most cancers. Shared lifestyle, environment and/or minor genetic changes may also be related to cancer risk in some families.

Some cancers  have specific features that suggest a risk may have been inherited from a parent, even when there isn’t a strong family history of cancer. Examples include: 


  • Breast cancer that is described as “triple negative” (negative results from testing the cancer for ER, PR and HER2 receptors)
  • Ovarian cancer that is described as high-grade serous (this includes similar cancer in the fallopian tubes or the peritoneum)
  • Cancer in the colon or the uterus that is described as missing “mismatch repair” proteins when testing is done on the tumour
Some people who have colonoscopy are found to have more polyps than expected, or unusual polyps, which may also suggest an inherited cancer risk.

Families with hereditary cancer are more likely to have: 

  • Several people with the same type(s) of cancer 
  • Cancer in relatives over more than one generation (e.g. grandparents and parents)
  • Cancer that starts at earlier ages than is common for that type of cancer (e.g. breast cancer or colon cancer before age 50)
  • People with more than one cancer diagnosis
  • People with less common cancers 
Those signs must be in people who are also related to each other (on the same side of the family) to suggest a cancer risk that might be passed down in the family.

If you have concerns about cancer in your family, talk to your doctor or nurse practitioner (MD/NP). Bring as much information as you have about relatives who have had cancer. Also talk to your relatives to find out if anyone has already started this process. Review of this information can help you and your MD/NP to decide about referral to HCP. For more details on personal and family history of cancer, review information in the "Eligibility" section.

If you learn that a relative has a hereditary cancer gene mutation, take that information to your MD/NP and ask to be referred to HCP. For more information, review "Carrier Testing" in the "Eligibility" section.
Self-referrals are accepted if a relative has shared details (e.g. letter, report, family reference number) about their hereditary cancer gene mutation.
 
Self-referral may also be an option if you are concerned about cancer in your family and do not currently have a family doctor or nurse practitioner.

To contact HCP, call the Vancouver office at 604-877-6000 local 672198, or the Abbotsford office at 604-851-4710 local 645236, or send an email to HCP.
The Hereditary Cancer Program (HCP) provides and recommends the resources below for those who seek additional information and support related to hereditary cancer. The BC Cancer Library  is also an excellent resource for information on cancer-related topics.

Pancreatic Cancer

Hereditary Breast/Ovarian Cancer 

Risk-reducing Mastectomy

Risk-reducing Ovary/Fallopian Tube Surgery


Multiple Endocrine Neoplasia Type 1 (MEN1)

Multiple Endocrine Neoplasia Type 2 (MEN2)

Polyposis

von Hippel Lindau Syndrome (VHL)

HCP Information for Health Professionals

 
Eligibility

Remember that cancer is common but hereditary cancer is not. This information may help you prepare to talk to your doctor or nurse practitioner (MD/NP) if you have concerns about cancer in your family. You may also wish to review some Common Questions (click tab above) or more detailed information about specific hereditary cancer syndromes.

Ask your MD/NP about referral to the Hereditary Cancer Program if you have been diagnosed with any of the following:

  • a hereditary cancer gene mutation through private pay genetic testing or a research study 
  • breast cancer at age 35 or younger
  • breast cancer described as “triple negative” (negative results from testing the cancer for ER, PR and HER2 receptors) and diagnosed at age 60 or younger
  • 2 separate breast cancers, with at least 1 diagnosed at age 50 or younger
  • ovarian cancer that is described as high-grade serous (this includes similar cancer in the fallopian tubes or the peritoneum)
  • breast or ovarian cancer and you have Ashkenazi Jewish heritage
  • colon cancer that is described as missing “mismatch repair” proteins when testing is done on the tumour
  • endometrial/uterine cancer that is described as missing “mismatch repair” proteins when testing is done on the tumour
  • unusual polyps or more polyps than expected when you had a colonoscopy
  • pheochromocytoma or paraganglioma
  • pancreatic cancer or multiple melanomas 
Click the “Carrier testing” tab below if a relative has already had genetic testing. 

Families with hereditary cancer are more likely to have: 

  • several people with the same type(s) of cancer 
  • cancer in relatives over more than one generation (e.g. grandparents and parents)
  • cancer that starts at earlier ages than is common for that type of cancer (e.g. breast cancer or colon cancer before age 50)
  • people with more than one cancer diagnosis
  • people with less common cancers 
Those signs must be in close relative on the same side of the family to suggest a cancer risk that might be passed down in the family.  

Talk to your MD/NP about Hereditary Cancer Program referral if your family history includes at least 2 of the signs above, OR if you have a close relative with any of the features listed in “Your Medical History” above. 

Close relatives include: children, brothers, sisters, parents, aunts, uncles, grandchildren & grandparents on the same side of the family. History of cancer in cousins and more distant relatives from the same side of the family may also be important.
If a relative shares details about a hereditary cancer gene mutation (e.g. letter, report, family reference number), take that information to your MD/NP and ask to be referred to the Hereditary Cancer Program to discuss carrier testing.

You may also refer yourself to the Hereditary Cancer Program with information about a family member’s genetic testing. To contact HCP, call the Vancouver office at 604-877-6000 local 672198, or the Abbotsford office at 604-851-4710 local 645236, or send an email.
Follow-up is available if you have already had a Hereditary Cancer Program genetic counselling appointment.

Reasons to request Hereditary Cancer Program follow-up include: 
  • new cancer diagnosis in yourself or a close relative 
  • new genetic test results in a family member
  • questions about: 
    • new options for genetic testing
    • cancer screening and risk-reduction
    • updated information related to a gene mutation in your family
    • available support services
Please contact the Hereditary Cancer Program to provide new information or to request follow-up. To contact HCP, call the Vancouver office at 604-877-6000 local 672198, or the Abbotsford office at 604-851-4710 local 645236, or send an email.
What to Expect
Hereditary Cancer Program referrals are usually made by a doctor or nurse practitioner (MD/NP). Review the Eligibility and Common Questions sections and talk to your MD/NP if you have concerns about cancer in your family.

This section provides information about what to expect when you are referred to the Hereditary Cancer Program (HCP). 

HCP staff review every referral to confirm things like:

  • Has someone in your family already had genetic testing? Do we have a report that confirms a specific hereditary cancer gene mutation was found? 
  • Does your medical history of cancer/other features fit our current criteria to offer an appointment?
  • Do we need to review other medical records? 
  • Do we also need to review your family history of cancer?
  • Are genetic test results required soon to help with decisions about cancer/other medical treatment? 
Depending on the information above, the next steps may include:
 
  • Booking a genetic counselling appointment for you
  • Booking a telephone appointment with you to get some more information
  • Sending you a family history form to complete
  • Sending you a letter that confirms you are on a waiting list to book a genetic counselling appointment
  • Sending a letter to inform you and your doctor that no appointment is needed
The sections below provide answers to some common questions about what to expect from a genetic counselling appointment. Click on each question for more information:

A genetic counsellor is a health professional with specialized education and experience in the areas of medical genetics, counselling and hereditary cancer. Genetic counselling is also provided by physicians with specialized training. 

The goals of genetic counselling are to help you: learn more about hereditary forms of cancer, understand the risks of developing cancer for yourself/your family, make informed decisions about genetic testing, and discuss options for cancer screening and/or risk reduction. Genetic counselling is available to adults and children whose personal or family history has features of hereditary cancer. 

A genetic counselling appointment includes:

  • Information about genes and cancer
  • Review of your medical information and your family history
  • Cancer risk assessment - information about your/your family’s cancer risks, options for cancer screening, and measures to lower cancer risks
  • Information about genetic testing (for more information, expand the "What is genetic testing?" section below)
  • Discussion about how this information may be important in your family, and how they may react
After the appointment, you and your doctor/nurse practitioner will receive a written summary of your cancer risk assessment and screening recommendations.
Genetic testing looks for an inherited change (mutation) in a gene that is known to increase the risk for specific types of cancer. It is usually done on a blood or saliva sample. 

Only about 5-10% of all cancers are linked to an inherited gene mutation. Genetic testing is offered if your personal and/or family history of cancer meets specific criteria.   

The first test in a family is usually offered to someone who has had cancer. This is called an index test. Storage of a blood sample may be a good idea for a person with uncertain health, if they might be the best index for genetic testing in a family. Please contact your MD/NP or the Hereditary Cancer Program to discuss this option.  

Most index genetic testing is currently done using a panel of hereditary cancer genes. Your genetic counsellor will review which genes are being tested and the possible results. 

If a hereditary cancer gene mutation is found, then a specific carrier test is available for family members. A carrier test looks only for the specific gene mutation that has been confirmed in your relative. 

Hereditary cancer genetic testing is usually offered to adults. It is available to children if the results will change their medical care. 

Genetic counselling is an important part of a decision to have genetic testing. For more information on genetic counselling, expand the "What is genetic counselling?" section above.
 
In May 2017, the Genetic Non-Discrimination Act (GNA) was passed into Canadian law. Under GNA, it is illegal to require disclosure of genetic test results or uptake of genetic testing as a condition of a contract. That means that an insurer or an employer cannot require you to have a genetic test or to disclose the results of your genetic test. Additional protections were also added under the Canadian Human Rights Act and the Canada Federal Labour Code.

For more information on genetic testing, expand the "What is genetic testing?" section above.
We offer in-person genetic counselling appointments at the HCP offices  in Vancouver and Abbotsford, and at BC Cancer Centres in Surrey and Victoria. 

We also provide appointments by video-conference to most communities in BC/Yukon. You will receive specific instructions from our booking clerk about where to go and what to expect. 

Some appointments are done by telephone. You should plan to be in a quiet and private area for a phone appointment.  

In-person and video-conference appointments are usually about 45 minutes. Telephone appointments may be 15-45 minutes, depending on the focus. 

Our booking clerk will contact you by phone and review the options when we are ready to book your appointment.
 
You are welcome to include another adult for support, or invite relatives who share similar concerns about cancer risk in your family.

In some cases we may suggest that you invite a relative who has had cancer and might be the “index” case for genetic testing in your family. For more information, expand the "What is genetic testing?" section above.
Our clerk will call you to book an appointment. If there is enough time, you will receive a confirmation letter that includes additional information. Please review that information carefully before your appointment. Your letter may include a suggestion to review one of these booklets:

You may be asked to print and complete some of the documents below:

You may choose to watch some short educational videos about genetic testing and cancer screening. This series of nine videos focuses on pancreatic cancer but the content of segments 2-7 can also apply to other types of cancer. Each segment is 2-3 minutes in duration.
The HCP team includes specialized physicians, genetic counsellors, nurses and support staff. Working together, we provide hereditary cancer risk assessment, genetic counselling and genetic testing. Our team also provides education (link to other section) about hereditary cancer topics. 

Physicians 

Vancouver:

  • Kasmintan (Intan) Schrader, Hereditary Cancer Program Co-Medical Director and Medical Geneticist
  • Sophie Sun, Hereditary Cancer Program Co-Medical Director and Medical Oncologist 
Vancouver/Victoria:

  • Gudrun Aubertin, Medical Geneticist (part-time with Hereditary Cancer Program)
Genetic Counsellors 

Vancouver:

  • Jennifer Nuk, Clinical Coordinator
  • Mary-Jill (MJ) Asrat
  • Carol Cremin (part-time) Familial Pancreatic Cancer Program 
  • Nili Heidary
  • Zoe Lohn
  • Tammy Petersen
  • Cheryl Portigal-Todd (part-time)
  • Jenna Scott (part-time)
  • Jennifer Thompson 
Abbotsford:

  • Angela Bedard (part-time)
  • Katie Compton
  • Allison Mindlin (part-time)
  • Ruth Thomas
Nurse Educator

Vancouver:

  • Mary McCullum
Support Staff 

Vancouver:

  • Mandy Jevon, Program Manager
  • Kim Barnaby, Clerk
  • Bianca Blake, Clerk
  • Hae Jung Min, Research Project Assistant
  • Sze-Wing Mung, Database Coordinator
  • Pawan Tung, Clerk
Abbotsford:

  • Chalaine Lawrance, Clerk 
  • Chelsea Poole, Clerk
High-Risk Clinic 

Vancouver:

  • Rona Cheifetz, High-Risk Clinic Medical Leader (part-time with Hereditary Cancer Program)
  • Marco Gnoato, High-Risk Clinic Nurse Practitioner (part-time with Hereditary Cancer Program)
  • Mary McCullum, Nurse Educator and High-Risk Clinic Coordinator


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