Blood test can define cancer risk

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Brenda Smith long suspected that her family history meant she had a much greater than average chance of getting cancer. Her mother was just 38 when she was first diagnosed with colon cancer. Her grandmother died at age 51 from ovarian cancer.

Recently, Smith’s doctor used a sophisticated blood test that confirmed that she has the genetic mutation that causes colon cancer. This fall, the 34-year-old mother of two plans to undergo surgery to have her colon and ovaries removed in the hope that she can avoid getting the disease. And through the test, she hopes to help her daughters avoid cancer as well.

“That’s basically why I (got the test), for my daughters,” said Smith, who last year had a hysterectomy after pre-cancerous cells were found in her uterus. “I want to know for their sake if there is any way they don’t have to go through what I went through.”

Smith is among the first eight patients that have been referred for the genetic tests to Iowa Health-Des Moines’ Stoddard Cancer Center, which began performing them earlier this year. She is one of two patients that so far have tested positive for the cancer trait, which means she has up to a 44 percent chance of getting ovarian cancer, compared with less than 2 percent among the general population.

Though the tests are just now being introduced by Iowa Health, Mercy Medical Center officials say Mercy has offered genetic blood screenings since 1999. It offers testing for the traits that can lead to melanoma as well as the same colon/cervical and breast/ovarian cancer tests that Iowa now offers.

“Our program is growing tremendously as our patients and physicians become aware of the benefits of genetic testing and counseling,” said Marilyn O’Donnell, coordinator of Mercy’s Family Risk Program, who declined to give specific figures. It’s estimated that between 5 and 10 percent of all cancers are caused by genetic factors, she said.

Other cities in Iowa in which the testing is offered include Mason City, Sioux City, Ames and Waterloo, O’Donnell said.

Previously, Iowa Health physicians primarily referred their patients to the University of Iowa Hospitals and Clinics in Iowa City for screening because many were familiar with the facilities there, said Pati Berger, the oncology clinical coordinator with the John Stoddard Cancer Center. However, that testing program, which ended in June after the nurse coordinating the program moved out of state, had a three- to four-month waiting list.

“For the most part, the physicians are excited to have it available and to have it so close and convenient for their patient,” she said. “And being able to do genetic testing makes us more of a complete cancer center.”

Each test costs about $2,500 if it’s the first person in a family to be tested, but can be much less for subsequent family members because the testing can be pinpointed to specific genes, Berger said. Many of the larger insurance companies are now paying at least a portion of that cost, Berger said.

Dr. Michael Page, a colorectal surgeon with the Iowa Clinic, said a “huge benefit” of the testing is that colon cancer is 100 percent treatable if detected early. About 150,000 Americans are diagnosed with colon cancer each year, making it the third most common type of cancer. Roughly 5 percent of those cases are thought to be genetically caused.

“Because colonoscopies aren’t recommended until age 50, this test will help us catch those 5 percent, where the person’s parents might have gotten cancer in their 40s,” he said. “And if you know early on that your family is at risk, your kids can colonoscopies when they’re 30 instead of when they’re 50.”

Most of the people O’Donnell has tested have already been treated for cancer in the past, she said.

“We can provide some information that they consider as far as prophylactic surgery, hormone therapy, or to be able to get early diagnostic testing at an earlier age,” she said. “Many times, people overlook the fact that men can carry the gene mutation for breast cancer. We have to look at the possibility from both sides because both the mother and father can pass along that gene mutation.

“One of the motivating things that bring people into the program is they can get information for the next generation,” O’Donnell said. “It’s a wonderful gift where people can share knowledge with their children or grandchildren.”

Smith said she wants her daughters to have the screening for colon and ovarian cancer when they reach puberty. One of her brothers also plans to be tested soon, and she’s trying to persuade her other two brothers, both of whom have daughters, to be tested.

“We really haven’t talked about it,” Smith said. “It’s kind of like a plague; they don’t want to talk about it until it comes. They’re real supportive until you talk about it for them.

“I think it’s a wonderful thing if you can prevent (the cancer) in any way, or at least you know it’s in your family and you can help somebody else, it’s a good thing.”