This health segment is presented by HCA Midwest Health. I'm Jamie Mansell with board-certified genetic counselor Lenna Levitch, and we're talking about genetic counseling. We start at the beginning. It seems like the words genetic counseling are pretty new to us and maybe especially in the field of oncology, can you say are just some basic information about what it is and maybe more importantly, what it's not sure I would just say that genetic counseling is a process, it's a conversation, really, where by the get counselors try to learn more about a patient's personal and family history. We're trying to put together the pieces of the puzzle and understand perhaps a little bit better about what might be going on. We want to try to educate patients about any medical conditions that we think might be inherited in their family, and we also want to help the patients make informed decisions through that process.

So, why would someone decide they actually need a genetic counselor?

Yeah, sure, that's a great question. There's lots of reasons specifically what my group deals with is hereditary, cancer, so about 50 to 10% of any kind of cancer. You can think of is inherited and by that I mean that these families are passing along the single gene mutation which is putting family members at risk for getting cancer. So sometimes there's family patterns of cancer or certain types of cancer running in families and an individual might be concerned that they might be at risk for getting that cancer or that they're, they themselves may have a hereditary form of cancer and they might want to pursue additional testing.

Is there any occasion where someone would want or need genetic testing because they got a suggestion from another doctor somewhere?

Oh sure, so there's lots of red flags for example, very young cancer individuals who are affected under the age of 50, multiple family members with the same kind of cancer, certain kinds of combinations of cancers like in cancer and uterine cancer or breast and ovarian cancer running in families.

We're even pancreatic cancer very unusual cancers so they may absolutely have physicians suggest to them because of their family history or personal history that they consider doing genetic testing.

I think genetic counseling is still term that a lot of people don't understand. It is complicated, it sounds very clinical and very, very medical. Can you talk us through the process? What does genetic counseling involved?

Usually, we ask patients to do a little homework so to fill out some paperwork ask some questions about their family history who had cancer, what kind... About how old were they? Even those healthy individuals are important to know as well and they bring that information to the session we go through that we draw what we call a pedigree. I know when we say that, people always smile like they think about dogs etcetera, but we do draw a pictorial pica gram of their family history to analyze that we go through some risk assessment, we talk about the pros and cons of genetic testing, what a person can learn from that, and what the limitations of those testing could be and also the emotional aspect of all of that. What's involved you, how do people feel What decisions might they make if they did the test and they found out they came back positive. And the implications for their family members as well as themselves.

Let's talk more about those implications. So that's really important about before when someone comes in, is there a conversation about, "Are you sure you wanna know and are you prepared to deal with what you're gonna learn?

Yeah, I do always bring that up but I don't know if everyone who comes in, gives that serious thought.

I think that everyone who comes in in the back of their mind, is pretty confident that they're gonna test negative that they're gonna come back with you know what they consider to be good news, and that they'll never be that one in 100 or 1, in 5000 persons that comes back positive.

There are some patients that absolutely decline doing this after they receive the information because they just don't wanna know Jamie, they just feel like that is too much burden on their plate and that that information is not gonna be powerful or helpful to them and I respect that. Can you play out for me a scenario, or two about the information that someone might get from genetic counseling and what they could do with that information?

I find out I am positive for this gene. What do you do with that? Because I think there are some, for example, I know I have a history of heart disease in my family. Okay, if you were to find something out like that, can you change your lifestyle or the things that you can do to prevent you from getting the thing that you are genetically pre-disposed to get?

Yes, I think that there are things that you can do. So I think as a counselors we like to think that what we're doing has some kind of role in change in the face of cancer and empowering patients to make decisions to perhaps prevent cancer, to lower the instance of the cancer. Because like you're saying, if you find out that you are at increased risk for breast cancer, for example, what kinds of things could you do well you can do earlier screening, you can do it more often, you can change the screening modality you can make better health choices. You perhaps wouldn't be a person that would go on hormone replacement therapy, and take them for 20 or 30 years. And so there are things that you can do. There's also very aggressive things like bilateral tomes and taking chemo, prevention. That can also reduce those risks so you can absolutely utilize that information, you can do all those things quite right and still get cancer, but you are absolutely going to reduce the likelihood of that by taking an active role.

I think the area of this that people are familiar with, or they're becoming a little bit more familiar with some of these ideas because we've had more of these direct consumer genetic testing is with a few years ago we had never really heard of at least just for you and me, who aren't doctor, right?

Can you tell me about the difference between what you do or the information that someone could get from a genetic counselor versus what they can get? One of these home kits?

Yeah, I, I think what we're looking for are really very different things. So, in pretty simplistic terms, at least that's kind of how I think of things.

When we do the gene testing, what we're basically doing is taking the manuscript or our DNA and we are checking proof reading every single letter in that manuscript looking for a mistake very comprehensive, very time consuming and we are looking at specific genes many of the direct-to-consumer test kits, do provide one testing for different kinds of cancer, or different genes.

But in general, I... They are not reading the whole manuscript. Let's say they're reading every 10th page, okay? And so they're getting little snips of the picture, but they're not getting the entire picture. And I think that that's the disservice to patients is that sometimes they don't understand that what they received was a very Arvid addition of what they really need and then so they're falsely reassured of that test comes back negative, that they're not at risk when in fact they looked at about a tenth of what they should have. Is there any danger in the opposite in a false positive, that might lead you to get a procedure you don't need? Oh yes, and we know that that's been going on because there have been lots of articles in the news and individuals in this area that receive positive test results had very aggressive surgeries and things and later on had testing redone at a different laboratory and found out in fact they did not carry that gene mutation.

So you do the consumer needs to be very conscientious and very aware of what they're doing and proceed, I think with caution and be fully informed.

I have a big question, but because the area of genetic testing is fascinating.

What's next in this area? A few years ago, we had never heard of these at home kits. And it's amazing the information that you can get now.

So where is it headed?

What's the next thing the person who sees an opportunity here, what are they looking at?

Oh, I don't know, that's a great question. I wish that I knew the answer because then I think all of us we cash in, we would see going to absolutely, they're going to I think a lot of these DNA tests and the labs that are doing more comprehensive testing are going to go to direct to consumer. The prices are coming way down patients no longer have to go through insurance because the prices that the labs are offering, is much more affordable.

The a big cardiology panels coming out for family histories of heart disease and different things like that.

So I think a lot more information is gonna be available and the important part of that is how to interpret that information. I think that's probably the most important part and piece that people who are interested in getting involved in.

That's where the science is going.

Thanks to board certified genetic counselor Lenna Levitch for joining us.