Who Should be Tested

Hereditary cancer syndromes have a major ethical, legal and psychological impact on the individual as well as family members and the caring physician.   As a result, a careful counseling before, during and after the testing is necessary.  There are many issues that one has to bear in mind before proceeding with the genetic testing. American Society of Clinical Oncology (ASCO) has published some guidelines for Genetic Testing of cancer patients and their families.  ASCO encourages oncologists to assume the responsibility of genetics counseling with patients and their families.

ASCO General recommendation as to indications for genetic testing:

• When a person has a strong family history of cancer or very early age of onset of disease

• Test can be adequately interpreted

• Result will influence medical management of the patient/family member.

ASCO Recommendation as to indications for genetic testing for Breast and Ovarian cancers:

• Family with more than two breast cancer cases and one or more cases of ovarian cancer diagnosed at any age

• Family with more than three breast cancer cases diagnosed before age 50

• Sister pairs with two of the following cancers diagnosed before age 50: two breast cancers; two ovarian cancers; or a breast and ovarian cancer.

• Relatives of individuals with breast cancer diagnosed before the age of 30

ASCO Recommendation as to indications for genetic testing for Colon and Rectal cancers:

• Colorectal carcinoma in three individuals, one of whom is the first degree relative of the other two with two generations affected and one of the cases diagnosed before age 50.

Despite the above recommendations, there are individuals who do not fit any of the above categories and yet like to be tested.  Such individuals need to be counseled to determine the appropriateness of genetic testing.

Cancer Genetic issues