NHCI Cancer Genetics Program

With recent advancements in technology and increasing attention from the media, much has been in the news about genetic testing for cancer risk. Although the genes a person is born with may contribute to their risk of developing certain types of cancer, only about 5-10 percent of all cancers are genetic. These cancers are caused by a broken or mutated gene that is passed down in families from one generation to the next.

Genetic counselors at the Northside Hospital Cancer Institute (NHCI) Cancer Genetics Program are specially trained experts that work with patients who are concerned about their family history of cancer and are considering genetic testing.

Genetics and Cancer

Cancer is usually caused by gene mutations that occur randomly in one or a few cells of the body. Such gene changes, called somatic mutations, may arise as a natural consequence of aging or when a cell’s DNA has been damaged. Acquired mutations are only present in some of the body’s cells, and they are not passed on from parents to their children.

However, in a small percentage of people with cancer, the disease is due to a different type of mutation called a hereditary mutation, or germline mutation. These mutations are usually inherited from one or both of the person’s parents, and are present in nearly every cell of the body. Because hereditary mutations are present in the DNA of sperm and egg cells, they can be passed down in families.

People who carry such hereditary mutations do not necessarily get cancer, but their risk of developing the disease at some point during their lifetime is higher than average.

In recent years, scientists have discovered a number of mutations that can contribute to a person’s risk of developing certain cancers, including breast, ovarian, colorectal and prostate cancer, as well as some other, less common cancer types.

Genetic Counseling and Testing

Genetic counseling occurs before genetic testing is considered. Meeting with a genetic counselor does not always mean a person is ready to have testing. Some people come in for an evaluation to learn about their options and to understand the implications of testing for themselves and their families. Our genetic counselors also help individuals understand how genetic testing might impact their family members since one genetic test has the potential to provide risk information for many family members at once.

Genetic testing is always most beneficial when it begins with the individual in a family who has or has had cancer. However, in some cases testing can also be done in someone without cancer because of the history in their close relatives.

Genetic testing for hereditary cancer risk can be valuable for several reasons.

  • It can help to determine if a cancer patient is at an increased risk of developing a second cancer in another part of the body
  • Each child of a parent with a gene mutation has a 50/50 chance for inheriting the altered genes.
  • Knowing about an inherited risk can help determine a person and their family's risk for developing other cancers and assist their doctor in recommending appropriate cancer screening measures.

To speak with a genetic counselor or Cancer Genetics Program staff member, please call us at 404-851-6284 or email genetics@northside.com.

Initial Visit

During an initial visit with a genetic counselor, patients receive an in-depth consultation to examine their personal and family history. Our staff will draw a detailed family tree, or pedigree. The goal of this visit is to understand how cancer develops, and how we assess the patient‘s (and their family members’) risk for different types of cancer. A genetic counselor will provide extensive information regarding genetic testing and will review different testing options and potential results. The counselor will also discuss the cost of testing, insurance coverage and legal protections from genetic discrimination, as well as the implications of both positive and negative test results. The counselor will a patient and their family may have about genetic testing.

When you come for a consult with one of NHCI’s certified genetic counselors, it helps to come prepared. Helpful information to know before your appointment:

  • Who in your family has been diagnosed with cancer?
  • Where did the cancer start? What type? Was it present in more than one place in the body?
  • What age was the family member diagnosed with cancer?
  • Has anyone in your family undergone genetic testing?

If a patient decides to proceed with a genetic testing, our staff will coordinate the testing process including the sample draw (most likely a simple saliva sample) and insurance coverage.

Follow-Up Visit

Patients are seen in-person for their results. During the follow-up visit, the genetic counselor will review the results to help patients understand the implications themselves and their family. The counselor will also review preventive and treatment options that may help families reduce their risk of cancer based on their test results. Even when a person tests negative for genetic mutations, they still may have a higher than average risk of cancer due to family history and some increased screening options may be available to them. All of that is reviewed during a results session with doctors and other specialists to ensure that they receive the testing results and that all of the patient’s questions are answered.

Patients who wish to begin collecting their family history information might find the following tool to be helpful: My Family Health Portrait - A tool from the Surgeon General

Insurance Coverage for Genetic Counseling and Testing

Most insurance companies will cover the cost of both genetic counseling and genetic testing. When patients call to make their initial appointments, we provide detailed information on how to determine coverage for their visit so they feel comfortable making an appointment.

Some people worry that their insurance company may discriminate because of a genetic test result; however, there have been very few documented cases of insurance discrimination and there are both State and Federal laws in place to protect individuals from such discrimination.

If you would like to learn more about genetic counseling and the implications of genetic testing, please attend one of our free monthly genetics education classes held at the Cancer Support Community Atlanta (near the Northside Hospital Atlanta campus).

To speak with a genetic counselor or a Cancer Genetics Program staff member, please call us at 404-851-6284 or email genetics@northside.com.

What Types of Cancers Are Hereditary?

Patients with a personal or family history of the following types of cancer are most often considered for a genetics evaluation:

It is important to remember that only about 5-10 percent of cancers are inherited so most often any of these diagnoses above are not due to an inherited risk.

Every woman has some risk of developing breast cancer. For the average woman this risk is around 12 percent (or 1 in 8). However, there are many factors that can influence a woman’s chances of developing breast cancer, and more and more is being discovered about how to best understand these influences.

It is well known that at least 5-10 percent of breast cancers and up to 25%percent of ovarian cancers are due to an inherited risk. Mutations, or changes, in two genes, BRCA1 and BRCA2, are the cause of most families with a hereditary risk for breast and ovarian cancer; however, additional genes have been discovered and testing is now available for these genes. Identifying families with an inherited risk can be one of the most important tools an individual can have to make sure they are receiving the most appropriate care that is personalized to their risk.

Individuals with the following history should consider a genetics evaluation for hereditary breast and ovarian cancer:

  • Diagnosis of breast cancer before the age of 45
  • Diagnosis of ovarian cancer at any age
  • A Male relative diagnosed with breast cancer
  • Two or more blood relatives - on either mother's or the father's side - diagnosed with breast cancer before the age of 50 or ovarian cancer at any age
  • Of Ashkenazi or Eastern European Jewish descent (90% of all American Jews are Ashkenazi)
  • A close family member that meets any of these criteria
  • History of any of the above criteria and previously tested negative for mutations in BRCA1 and BRCA2

As the third leading cause of cancer-related deaths, colorectal cancer affects more than 130,000 men and women each year. Most of these cases are sporadic; however, about 5-10% of colon cancers are hereditary. The most common cause of genetic colon cancer is a condition called Lynch syndrome. Individuals and families with Lynch syndrome tend to have colon cancers diagnosed at earlier ages (before 50), and may have had other types of cancer diagnosed, including endometrial (uterine), gastric (stomach), ovarian, kidney, pancreatic and small bowel. Anyone who has been diagnosed with several of these cancers or whom have close relatives diagnosed with these several of these cancers should consider a genetics evaluation for Lynch syndrome

Having a personal or family history of developing multiple colon polyps is another genetic form of colon cancer. Sometimes these polyps are pre-cancerous (also called adenomas) and sometimes they are not, but they are still present in large numbers (more than 20). If you or close family members have had many polyps removed throughout their lifetime, it could be due to an inherited risk. Sometimes these family members may have had a cancer diagnosis, but not always. Colonoscopy results are not often shared among family members, so it is important to for people to discuss colon polyp history with their close relatives as this could give important clues as to whether there is an inherited risk within a family.

There have also been newer genes discovered that can lead to increased colon cancer risks in families. Testing has expanded to include these genes, and meeting with a Northside genetic counselor is the best way to receive up to date information about genetic risk for colon cancer.

Individuals with the following personal or family history should consider a genetics evaluation for hereditary colon cancer:

  • Diagnosis of colon cancer before age 50
  • Diagnosis of endometrial (uterine) cancer before age 50
  • Three or more close family members (or an individual and two family members) diagnosed with colon, endometrial (uterine), stomach (gastric), pancreatic, small bowel, kidney, or ovarian cancers
  • History of more than five pre-cancerous polyps (total in a lifetime)
  • Colonoscopy resulting in unusual types of polyps, including juvenile polyps and hamartomatous polyps

Our Locations

The Cancer Genetics Program has multiple locations available for patients to meet with our genetic counselors. Our goal is to bring genetics services to patients living throughout Georgia, especially those in geographic areas with limited cancer genetic service available. In addition to in-person consults, we offer telegenetics consults at multiple medical oncology locations across Georgia

To speak with a genetic counselor or Cancer Genetics Program staff member, please call us at 404-851-6284 or email genetics@northside.com.

Cancer Genetics Program Locations
To schedule an appointment with a genetic counselor call 404-851-6284
Click on links below for detailed address information and directions
Northside Hospital Atlanta Campus – Center Pointe
Building II, Suite 350
Northside Hospital Alpharetta Medical Campus
Building C, Suite 155
Northside Hospital Cherokee Campus – Radiation Oncology
Northside Hospital Forsyth Campus – Radiation Oncology
Northside/Holly Springs Imaging Center
Northside/Stockbridge Imaging Center