April 18, 2013 | by Darrin Joy
Genetic screening is gaining prevalence — and impact — worldwide. Through such tests, patients can better understand their risk of developing cancer, or a recurrence if they’ve already been diagnosed, and then act to limit that risk. Further, research continues to unveil new genetic clues that could help assess a person’s likelihood of developing several cancers. And two companies, Genomic Health and Myriad Genetics, have even developed genetic tests that can help gauge how aggressive a patient’s prostate cancer is.
But in some parts of the world, people lack access to clinicians capable of understanding the results of these genetic tests; as a result, their ability to make informed decisions suffers. A one-of-a-kind course on cancer genetics, taught by City of Hope researchers, is helping to change that.
For more than a decade, City of Hope’s Division of Clinical Cancer Genetics, headed by Jeffrey Weitzel, M.D., has offered courses and resources to train clinicians in clinical cancer genetics best practices — and people around the nation, and the world, are now benefiting. One of the most far-reaching offerings is the Intensive Course in Cancer Risk Assessment.
Since its formation in 2001, the course has trained 275 clinicians from 47 U.S. states and 11 countries.
Ana María Carvajal, M.D., a specialist in breast medicine from Medellin, Colombia, attended the most recent class. She and her colleagues in Medellin aim to develop a national network of professionals to offer genetic cancer risk assessment and counseling to Colombians.
“We are trying to improve our genetic counseling system in … Colombia because we don’t have clinics for just counseling and cancer,” she said following a workshop at the City of Hope session in March.
Part of the challenge is lack of interest among older clinicians. “I have some colleagues that say, ‘I just want to work; I don’t care about genetics,’” she said.
Lagging awareness of risk factors among patients, particularly incidence of disease among family members, is a major barrier, as well.
“Our patients usually don’t talk about familial risk,” she said, “so we … ask them if there’s any other cancer in the family.” But they rarely know. Carvajal hopes to change the prevailing attitudes.
“We must create a culture to access genetic counseling in patients [and] doctors. They need to start thinking about family members that can benefit,” she said.
One way to do that is to bring ideas from City of Hope’s course to a younger generation of clinicians.
“When I got my medical doctor degree, nobody told me about genetic risk counseling. It wasn’t in my training,” she says. “We’re trying to move these ideas and programs to university and medical schools. If we put these ideas in young medical doctors’ minds, they are going to think about it in the future. So if they catch a patient, they will ask about family history and look for some cancer risk, and they can recommend genetic counseling before any cancer appears.”
Minnesota medical oncologist Thomas Armatruda, M.D., has found that similar resistance once common among an older generation of U.S. doctors is now lessening.
“The interesting thing is the older ones didn’t embrace it because they were afraid of it,” he said. “[They] had been doing things the way they wanted for a long time and they didn’t think they needed to change how things were done. Now I think they realize they have to. And a new group of young people comes in and they just assume that this is the standard of care.”
He sees the cancer genetics field that City of Hope has been helping to define as integral to the future of medicine.
“Everybody recognizes that this is important and that this is just the tip of the iceberg,” he said, “because the genetics of prevention is just part of the much bigger genetics of treatment of cancer, and to understand that you have to understand genetic principles. And that’s what’s going to become the standard of practice going forward.”
The course is supported in part by National Cancer Institute grants IRC4CA153828-01 and 1R25 CA112486).