Penn State Health St. Joseph Cancer Center uses genetic evaluation to determine patients’ cancer risk and provide actionable next steps through their Cancer Risk Evaluation Program (CREP).
Marc A. Rovito, MD, medical oncologist- hematologist and medical director of Penn State Health St. Joseph Cancer Center, and Donna Lamp, RN, BSN, CCM, coordinator for the Cancer Risk Evaluation Program at Penn State Health St. Joseph Cancer Center
Patients in central Pennsylvania who have a family history of cancer — roughly 5% to 10% of cancer cases are hereditary — can now benefit from being professionally assessed through Penn State Health St. Joseph Cancer Center’s CREP. If individuals are concerned about their risk of developing breast, ovarian, colorectal or other hereditary cancers, providers through the CREP will provide information, evaluation, genetic counseling and genetic testing, if appropriate, to assist in developing a realistic assessment of a patient’s risk status. The CREP staff works collaboratively with the patient’s physicians to review the patient’s personal cancer risk factors and family history to create a cancer-incidence pedigree (or family tree) and offer recommendations for follow-up.
“It really is a proactive approach to a patient’s cancer risk and ongoing screening plan,” says Donna Lamp, RN, BSN, coordinator for the Cancer Risk Evaluation Program at Penn State Health St. Joseph Cancer Center. “We help them put puzzle pieces together, identify a possible reason why cancers are occurring in their family and inform them about what can be done. We provide a comprehensive risk management plan for those individuals to reduce their risk of cancer or at least to detect cancer at its earliest stage through personalized screening measures.”
Helping Patients Since 2004
The CREP program actually started as a community pilot program in 2004, and the community expressed a return interest. Lamp has been with the program since the beginning, and as the program’s RN coordinator, she primarily performs the risk assessments and constructs the family pedigrees. She has access to a medical geneticist and genetic counselors through Penn State Hershey Cancer Genetics Program.
“We have patients complete a family history form that consists of three generations,” Lamp says. “We ask them to list all of the individuals in their family, even if they are unaffected by cancer. We go as far as first cousins, and even include that next generation of great aunts, uncles and grandparents, because they are recognized as close relatives. We get them to specify age, cancer diagnosis and the type of cancer it was. We ask them to provide as much information as they can.”
They also look for certain red flags that indicate an elevated cancer risk.
“We look for young onset cancers before age 50 and a pattern of cancers that may be associated with certain hereditary cancer genes,” Lamp says. “We also look for other cancers that may be considered rarer, such as ovarian cancer or pancreatic cancer.”
A Spectrum of Services
For each patient, the CREP’s oncology professionals will:
- Determine a patient’s risk of developing hereditary cancer through a thorough evaluation of lifestyle, medical history and family history.
“We actually construct a three-generational pedigree,” Lamp says. “This is a bird’s eye view of that patient’s family, so it gives us a pretty good idea of the patient’s family cancer risk. We can input the patient’s individual cancer risk factors into a software model. For example, for a woman we may ask, ‘At what age did you have your first child? At what age did you have your first period? Did you ever take any hormones? Do you have dense breast tissue?’”
- Develop a plan for ongoing screening and risk reduction approaches.
- For breast cancer specifically: Assist women in understanding prevention, diagnosis and treatment via current breast health management issues and research studies; help patients understand their personal risk status and if they are at increased risk due to known factors, including hereditary; and provide counseling and access to genetic testing and clinical trials for women at high risk.
- Set in motion a plan for ongoing screening and risk reduction approaches for individuals with hereditary breast, ovarian, or pancreatic syndrome, Lynch syndrome and other known cancer-related genetic syndromes.
The ultimate goal is to provide screening and strategically reduce cancer risk for patients and their families based on family and personal history and through collaboration with medical oncology specialists, surgeons and pathologists, and referral to other healthcare providers as indicated.
The Results of Evaluation
Based on the results of the initial evaluation, providers with the CREP might recommend that a patient have genetic testing done. A blood or saliva test can determine whether the patient carries a hereditary gene mutation that puts them at higher risk of developing cancer. Once a patient’s cancer risks are evaluated, the CREP provider puts together a plan — a series of written recommendations for reducing the patient’s cancer risk. Those may touch on things like diet, exercise, preventive medications, possible risk reduction surgery, and, especially, a schedule for regular checkups and cancer screenings.
“Most often, our patients are not diagnosed with cancer,” Lamp says. “But they are getting a good risk mitigation plan. And with that, we can detect cancer at its earliest stage, making it easier to treat and possibly cure.”
For more information about Penn State Health St. Joseph Cancer Center’s Cancer Risk Evaluation Program, call 610-378-2457 or read thefutureofhealthcare.org/assets/CREP.pdf.