Fear or Guilt May Impede Cancer Genetic Testing, But an Oncologist Says It Shouldn't

Genetic test results may not only guide cancer treatment decisions but can also inform a patient if their relatives are at risk for a diagnosis, too. While most patients embrace the advances in having their DNA tested, there is a minority who prefer not to know, explained Dr. Ami P. Vaidya.

Vaidya is the co-chief of the division of gynecologic oncology and vice chair in the department of Obstetrics and Gynecology at Hackensack Meridian Health University Medical Center. In a recent interview with CURE®, she discussed the importance of genetic testing and why some people might be apprehensive about the process.

Facing the Fear of Another Cancer

“For some folks, they’ve just been really overwhelmed by the diagnosis and treatment, and then to have to think about being at a higher risk for another cancer can feel really overwhelming,” Vaidya said.

Vaidya said that she understands this fear of secondary cancers, which can be particularly intimidating if there is nothing that can be done to stop another diagnosis in the future. But that is often not the case.

“The reality is that for a number of different cancers, there are various interventions, and there are things that we can do to help reduce risk,” Vaidya said.

Preventive measures can include earlier and/or more frequent screening, or even prophylactic surgery – like a mastectomy or oophorectomy – to remove the body parts that are at highest risk for cancer, thus potentially preventing the diagnosis completely.

Familial Risk for Cancer

“The other side is that we see a lot of guilt… for patients where they’re concerned that if they test positive for a mutation, they have put their family members at some kind of risk,” Vaidya said, explaining that for some genetic mutations, like BRCA, there is about a 50% chance of a childing harboring the mutation if their parent tests positive.

A family member of a patient with cancer who has the same genetic predisposition to the disease is likely also eligible for more screening or preventive measures. Not to mention, having family members undergo testing may offer some peace of mind.

“We don’t have control over our genetics… having a mutation doesn’t automatically incur a cancer diagnosis. And there is a 50% chance they won’t have the mutation. Sometimes knowing that can be a real relief,” Vaidya said.

Whenever Vaidya treats patients who harbor a genetic risk, she encourages them to share these findings with their loved ones. If they are nervous about doing so, Vaidya said that she and her team are there to help by walking through conversations determining possible reactions to the news or having a video or telephone call with the patient and their loved one where she is available to answer any questions that come up.

Vaidya also emphasized the importance of genetic counselors when having these conversations.

“Genetic counselors are excellent at doing this. They’re professionals who have the most information about all the changes that are happening in genetic testing and the impacts,” she said. “Oftentimes, they’ll have family meetings and we’ll be able to go over results or talk about what’s the next best step and testing for family members.”

Ultimately, Vaidya said that she is excited about how far genetic testing has come, though there is still far more work to be done.

“Going back to what we used to understand about genes years ago to where we are today is mind-boggling,” she said. “There is one caveat, though. We don’t have all the answers.”

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