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Resources for Providers

Resources for Providers

*** Quick Link: Hereditary Cancer Toolkit ***
(No-cost resources for clinical use and professional development)

 

MDHHS, the Centers for Disease Control and Prevention (CDC) and others are partnering to promote evidence-based cancer genetic practices throughout the state. The information on this page provides a general overview of these best practices.

Cancer genomics best practices encompass the following:

  1. Documentation of a patient's personal and family history of cancer to enable risk assessment
  2. Use of hereditary cancer risk assessment tools and referral to appropriate cancer genetic services
  3. Appropriate genetic counseling and testing for hereditary cancer
  4. Appropriate interpretation and discussion of results with patients

Examples of Cancer Genomics Best Practices from Michigan health systems:

 

Cancer Risk Assessment

For an introduction to hereditary cancer, watch this lecture video on Cancer Genomics 101.

Finding and managing a hereditary cancer condition can help identify cancer early and save the lives of patients and their at-risk family members. Not all cancer is passed from one generation to another, but there are some "red flags" for hereditary cancer conditions.

  1. Multiple family members have been diagnosed with the same cancer or cancers that are related to each other.
  2. Patient or a family member was diagnosed before the age of 50.
  3. Patient or a family member was diagnosed with bilateral cancer.
  4. Patient or a family member had two primary cancer types.
  5. Patient or a family member was diagnosed with a rare type of cancer (eg., ovarian, male breast cancer, pancreatic cancer).
  6. Patient has Ashkenazi Jewish ancestry.

Additionally, immunohistochemistry (IHC) and/or microsatellite instability (MSI) testing for colon and endometrial cancers can guide screening for hereditary conditions such as Lynch syndrome. Taking a complete family history is very important. Visit the following links to keep up to date with guidelines for cancer genetic referral and testing:

For general information and patient resources, see the MDHHS Lynch Syndrome and HBOC pages.
 

Family History Collection

Proper documentation of personal and family history of cancer is a valuable tool for assessing a patient's risk of inherited cancer conditions. Where appropriate, health histories should include:

  1. Presence of known hereditary cancer syndrome in the family
  2. Type of cancer diagnosed in the patient and family members
  3. Age of onset of cancer
  4. Number of relatives affected
  5. Number of individuals with multiple primary cancers
  6. Relationship of patient to affected individuals
  7. Ancestry

This process can take a lot of time in clinic. One way to collect family history is to provide a questionnaire beforehand and review it during the appointment. Try ASCO's Cancer Family History Questionnaire. ASCO also provides information on Assessing & Managing Your Patient's Hereditary Cancer Risk. 
 

Cancer Genetic Counseling and Testing

Cancer genetic counseling from a qualified professional involves information-gathering, evaluation, and risk assessment for hereditary cancer. Genetic counseling may not necessarily lead to a referral for genetic testing. The genetic counseling process includes discussions about the implications of test results, appropriate related clinical services and/or interventions, and cascade screening for first-degree adult relatives.

When genetic testing is recommended, Michigan law requires that written informed consent be obtained from the patient before any pre-symptomatic or predictive genetic tests are performed. Providers are responsible for providing information to their patients about the purpose, risks, benefits and limitations of genetic testing and the appropriate interpretation of test results.

For an overview about why genetic testing could help in determining if someone might be at risk, view the video "Genetic Testing for Inherited Risk for Cancer." For additional resources on genetic counseling, genetic testing, and informed consent (Including GINA), check out our Cancer Genetics Toolkit.

 

Cascade Screening

When an individual is found to have a cancer-causing mutation (pathogenic variant), genetic counseling and testing should then be offered to their first-degree relatives (parents, brothers, sisters, and children). This process, called cascade screening, involves communicating the test result to these relatives, who must then share the information with their providers and seek an appropriate referral for counseling and genetic testing for the known mutation. Testing for the specific pathogenic variant that has been found in the family is highly informative and less expensive than comprehensive or panel genetic testing.

For first-degree relatives not found to have the pathogenic variant, no additional testing is necessary for their lineage. For those found to have it, genetic counseling and testing should be offered to their first-degree relatives. This cascade screening process continues through each subsequent generation.

Cascade screening identifies individuals with the highest risk of having cancer-causing mutations, so they can then engage in early or more frequent tumor screening and other interventions to reduce their risk of developing cancer.

Some patients may have difficulty communicating this information with their family members and ask for assistance from their provider. For resources on cascade screening and family communication, check out our Cancer Genetics Toolkit.
 

Continuing Education for Providers

Health care professionals can earn CME credits using online resources on hereditary cancer and cancer genomics best practices.

  • FREE CME/CNE module: "Hereditary Cancer Syndromes: Are Your Patients at Risk?" developed in partnership with the Jackson Laboratory to develop skills and knowledge to identify patients who are most appropriate for genetic testing, choose the right test, counsel patients and use the results to develop a management plan.
  • Clinical and Continuing Education CME at the Jackson Laboratory - Online programs, interactive workshops and blended learning opportunities for health care providers.
     

Contact Us

If you have questions, call the MDHHS Genetic Information Line at 1-866-852-1247 or email genetics@michigan.gov. For cancer genetic counseling and testing services in your area, visit the Directory of Clinical Cancer Genetic Services in Michigan.

Public Health Genomics Section 
Lifecourse Epidemiology and Genomics Division 
P.O. Box 30195
333 S. Grand Avenue
Lansing, Michigan  48909-30195

 Cancer Genomics Home Page

 

Funding for this program was made possible (in part) by the Centers for Disease Control and Prevention. The views expressed in written materials, publications, or webpages do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Last updated: 6/23/2022