Expanding the Oncology Team: Welcome the Cancer Geneticist

Although it is certainly true that each step in any NCCN algorithm must receive due consideration, sometimes it is the most obvious things that need restating, lest the eye skip over something that might, on superficial reading, appear perfunctory. A case in point is the carefully worded Genetics/Familial High Risk Assessment Clinical Practice Guideline.In keeping with the formula for NCCN supportive care guidelines, the algorithm proposes screening as the first step, followed by a detailed risk assessment if the screening result is positive. What must not be glossed over, however, is the important recommendation joining these clinical decision nodes: “Referral to cancer genetics professional recommended.” The geneticist is the health care professional who can perform the sophisticated pedigree analysis that determines whether genetic screening is warranted. If the patient decides to undergo testing, the geneticist's role becomes even more involved, with a mandate to “provide counseling, including psychosocial support and assessment, risk counseling, education, and discussion of genetic testing, and obtain informed consent.” This mandate is a far cry from a well-meaning but inadequately trained oncologist taking a cursory family history and ordering a blood test, the results of which might be delivered by a member of the office staff.Special attention should be given to the components of a meaningful informed consent. The American Society for Clinical Oncology Special Article on Genetic Testing for Cancer Susceptibility1 details 12 basic elements needed for truly informed consent for cancer susceptibility testing: information on the specific test; implications of a positive...

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Rodger J. Winn is the Editor-in-Chief of JNCCN. He is Clinical Consultant at the National Quality Forum, and his past positions include Associate Professor of Clinical Medicine at The University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

References

1.

American Society of Clinical Oncology Policy Statement Update: Genetic testing for cancer susceptibility. J Clin Oncol2003;21:23972340.

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