Skip to main content

Hereditary

 
Refer

Referrals to the Hereditary Cancer Program (HCP)

The HCP Referral Form is used to refer patients from all parts of BC/Yukon. Please print the form, provide all relevant information, and fax it to the appropriate HCP office.

Abbotsford
The HCP office in Abbotsford receives and processes referrals for people who wish to have a genetic counselling appointment at the BC Cancer Agency's Centres in Abbotsford and Surrey.

Vancouver
The Vancouver office of the HCP receives referrals for patients who wish to have a genetic counselling appointment in Vancouver, Victoria, Kelowna, Prince George or by video conference to many communities across BC/Yukon.

Please note:

  • Referrals may be made for individuals with or without a personal diagnosis of cancer
  • The family history will be assessed by the HCP to identify the type of consultation that is indicated
  • Appointments can usually be booked within 12-15 months from the return of a completed Family History Form (sent to the patient by the HCP office)
  • Genetic testing may or may not be offered in the course of a genetic counselling appointment
Information about other hereditary cancer syndromes can be found on the GeneTests website. For information on specific syndrome criteria, please visit the Hereditary Cancer Syndromes section.

Expedited/urgent referrals to HCP

Reasons to request hereditary cancer assessment on an expedited basis include:

  • Patient is eligible for carrier testing - specific hereditary cancer gene mutation has already been identified in a close relative (report required)
  • Unstable health status of family "index" case - see "Urgent DNA Storage" section below
  • Genetic test results will impact patient's immediate clinical management - see Expedited BRCA1/2 index testing for additional information
Requests for urgent assessment are reviewed promptly by HCP staff. Please provide timeline and reason for expedited assessment. The referring physician will be contacted if additional information is required to support the request, or to explain why the HCP is unable to provide an expedited appointment.

Urgent DNA Storage

Storage of a blood sample may be indicated on an urgent basis when the health of an affected "index" patient is of concern. The goal of storing a blood sample is to allow for the possibility of future hereditary cancer genetic testing in a family. No testing is done on a stored blood sample until the appropriate family member has had genetic counselling and completed an informed consent process.
 
When possible, HCP staff should be contacted to provide the required paperwork and plan for appropriate follow-up. If HCP staff are not available, any physician/NP can print and use the Urgent DNA Storage Requisition, Consent and Family Info form.
Guidance

Anyone from a family with a confirmed mutation in a hereditary cancer gene can be referred for genetic counselling

See the referral criteria for specific hereditary cancer syndromes. These guidelines are modified on an ongoing basis to reflect new information.

Pertinent family history may be found either on the maternal or paternal sides of the family, but should be in close relatives* on the same side of the family. 

Referral may also be made for assessment of a significant family history that does not appear to fit a specific syndrome but includes some of the following features of hereditary cancer:

  • 2 or more closely related family members with the same type of cancer
  • A pattern of cancer over at least 2 generations
  • Cancers diagnosed at an earlier age than expected in the general population
  • Multiple primary cancers in an individual
  • An unusual clustering of cancers

What happens next?

All Hereditary Cancer Program referrals are assessed. Follow-up with the patient may include:

Hallmarks of Hereditary Cancer:

  • 2 or more closely related family members, on one side of the family, with the same type of cancer
  • a pattern of cancer over at least 2 generations
  • cancers diagnosed at an earlier age than expected in the general population
  • multiple primary cancers in 1 individual
  • combinations of cancers associated with a known hereditary syndrome (e.g. breast and ovary; colon and uterine)
  • specific pathology types (e.g. serous ovarian cancer)
See sample family histories below, and the interpretation provided. Breast cancer is used in these examples, but the same principles apply to other types of cancer. 

Key: circle=woman, square=man, filled in= type of cancer & age at diagnosis

Sporadic Cancer = single occurrence in a family

Sporadic Cancer = single occurrence in a family
  • 70-75% of family histories
  • majority of cancer cases
  • diagnosis at typical ages
  • related to common risk factors like age, diet, environment
  • inherited risk unlikely
Genetics consult not indicated

Familial/Multifactorial Cancer = cluster of cancer within family

Familial/Multifactorial Cancer = cluster of cancer within family

  • 20-25% of family histories
  • 2 or more close relatives with cancer
  • diagnosis at typical ages
  • may be due to chance alone
  • may reflect combination of shared environmental and moderate genetic risk factors
Genetics consult not indicated

Hereditary Cancer = inherited cancer predisposition


Hereditary Cancer = inherited cancer predisposition

  • 5 - 10% of all cancers
  • younger ages at diagnosis
  • individuals may have multiple primary cancer diagnoses
  • autosomal dominant inheritance -  pattern over generations
Referral to Hereditary Cancer Program is indicated.

  • refer affected family member first if possible
  • genetic testing may be available
 
The goals of genetic counselling are: to help individuals learn more about hereditary cancer, to understand their own risk of developing cancer, and to learn about options for cancer screening and/or risk reduction. If genetic testing is available, genetic counselling helps people to make informed decisions about whether such testing will be helpful for themselves and their families.

Genetic counselling includes:

  • detailed review of the reported family history, with special attention to anyone who has had cancer
  • assistance with collecting relevant medical records in order to provide accurate risk assessment
  • explanation of differences between sporadic cancers (occur by chance in the population, therefore, everyone has the same risk) and hereditary cancers (seem to run in families and may be linked to an inherited mutation in a specific gene). See Assessing Family History for examples.
  • interpreting any pattern(s) of cancer in the family history; some people may learn that their cancer risk is lower than they thought, and others may learn that their risk is higher
  • discussion about whether genetic testing is possible, and if so, who is the best "index" case for the family; usually hereditary cancer genetic testing starts with a person who has had cancer.
  • review of the genetic test process, if available, including possible results, potential impact on family dynamics, and other risks, benefits and limitations
  • support with informing family members
  • current recommendations for cancer screening and/or prevention of cancers for which the person may be at increased risk
Residents of BC/Yukon who are interested in hereditary cancer genetic counselling should review their family history with their physician to decide if referral to the Hereditary Cancer Program is indicated. 
 
Hereditary cancer genetic testing is "not just another blood test".

Eligibility criteria have been established by the Hereditary Cancer Program to ensure a consistent and equitable approach. Our goal, within the scope of current resources, is to maximize the availability of appropriate genetic testing that has impact on the medical management of individuals and families in BC/Yukon.

To provide informed consent, genetic counselling is required prior to blood samples being accepted by the Hereditary Cancer Program for genetic testing.

Genetic testing can be a lengthy, complicated laboratory process. When criteria have been met to test a specific hereditary cancer gene, there are 2 primary approaches: index or carrier testing.

1) Index Testing

  • first gene test in the family
  • usually offered to a person who has had cancer, so Urgent DNA Storage may be indicated if there is concern about the health status of a potential index case for a family
  • goal is to confirm whether a specific gene is associated with the pattern of cancer in the family
  • involves testing of entire gene(s) to try to identify a mutation that interferes with the gene function
  • results may take many months
  • expedited BRCA1/2 index testing is available on a limited basis
  • results can confirm hereditary cancer but cannot rule it out:
    • if a mutation is identified, the hereditary cancer syndrome is confirmed and carrier testing is available to family members. Children and siblings of the "index" case will have a 50% chance of having inherited the same mutation.
    • if no mutation is identified, hereditary cancer is not ruled out. It is possible that a mutation exists but was not detected with current technology, or that another gene is associated with the family history of cancer. In some cases it is appropriate to followup by offering index testing to another affected family member.
  • 10-15% of results are of uncertain clinical significance
2) Carrier Testing

  • available when a specific gene mutation is already confirmed in the family
  • tests only for the presence/absence of that specific gene mutation
  • result confirms carrier status and associated cancer risks, but cannot predict when/if the individual will develop cancer
    • positive result - person has inherited an increased risk to develop specific types of cancer
    • negative result - person did not inherit an increased risk but remains at population risk for common cancers
  • family member genetic test report (if available) should be included with a referral for genetic counselling

Refer to information about a specific hereditary cancer syndrome for details about the genes involved.

 
Close relatives include: children, brothers, sisters, parents, aunts, uncles, grandchildren and grandparents. History of cancer in cousins and more distant relatives from the same side of the family may also be relevant.


Resources

Education materials for healthcare providers are available at no charge from the Hereditary Cancer Program (HCP). To order resources, email the order form to HCP Information, or fax the order form to 604-707-5931.

Brochures

Forms

Guidelines & Manuals

Scientific publications

Videos

Tab Heading
SOURCE: Hereditary ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © Provincial Health Services Authority. All Rights Reserved.

    Copyright © 2017 Provincial Health Services Authority