Cancer Genetics at USC Norris Comprehensive Cancer Center is paving the way for early detection and preventive strategies in cancer.
Approximately five to 10 percent of cancers develop out of hereditary risk. Early detection is key, which is why our advanced tactics and tools are meant give you and your family members the best approach to preventing and fighting cancer.
Cancer Genetics at USC Norris provides a comprehensive evaluation with a goal of identifying inherited cancer risks and providing appropriate options for cancer screening and prevention for you and your family members. We use leading technology to evaluate cancer risk and provide a personalized approach to screening, prevention and treatment as necessary. If a genetic alteration related to cancer risk is identified, we work with your doctors to help them make the best choices in guiding your medical management. We also offer services to our patients’ extended family if they may need additional testing.
Patients for whom genetic testing is appropriate include:
- Those with diagnosis of cancer at an earlier age than average (less than 50 for common cancers like breast or colon, for example)
- Those with more than one relative with the same or related cancers in the family
- Individuals with more than one primary cancer
- Individuals with rare or unusual cancers
Cancer Genetics is here to support the patients who have concerns about cancer risk. We make every attempt to work with our patients to help you understand the implications of the genetics evaluation and genetic testing results. We also take the time to ensure you have an accurate family history and are prepared for your appointment.
Our multidisciplinary team is made up of physicians and genetic counselors who specialize in cancer. We are a highly responsive, patient-focused service, which can schedule and see patients on a timely basis. We offer same-day consults for urgent situations or patients traveling from a far distance. All cases and results are discussed in a weekly cancer genetics case conference allowing for coordinated, comprehensive care.
As part of an academic medical center, Cancer Genetics uses the latest technologies in genetic testing by using multi-gene hereditary cancer panel tests. Our specialists are actively contributing to the cancer genetics literature and stay current on the latest developments in the field. Research is large part of our practice as well, in that we are actively looking for new genes that may contribute to cancer risk and new methods of using a personalized approach to cancer prevention.
Cancer Genetics offers evaluations for patients and families with a wide range of cancers, including breast, colorectal, ovarian, uterine, pancreas, melanoma, kidney, thyroid, stomach and other cancers.
When a condition is identified, our multidisciplinary team provides patients with a specific prevention and screening program offered to prevent cancer or to identify cancer at an early, treatable stage. Our team screens for the following conditions:
Hereditary breast and ovarian cancer syndrome is a hereditary condition which can be caused by a mutation in the BRCA1 gene or the BRCA2 gene. Women with a mutation in one of these genes have a higher risk of breast and ovarian cancer. Men who have a mutation in these genes have a higher risk of prostate cancer as well as male breast cancer. Genetic testing for breast and ovarian cancer typically includes a comprehensive panel of genes associated with these cancers. Other breast or ovarian cancer genes typically tested include BARD1, BRIP1, CDH1, CHEK2, NBN, PALB2, PMS2, PTEN, RAD51C, RAD51D and TP53. Individuals with mutations in these genes are provided with screening and prevention guidelines.
Lynch syndrome is a hereditary syndrome, which can increase the risk of colorectal and uterine cancer and is associated with stomach, ovarian, urinary tract and other cancers. Mutations in a number of genes are associated with Lynch syndrome, including MLH1, MSH2, MSH6, PMS2 or EPCAM. These genes typically repair “mismatches” of DNA that can occur when cells divide. Individuals who have Lynch syndrome are offered enhanced screening to prevent cancer.
Cowden syndrome is a hereditary condition associated with mutations in the PTEN gene. The syndrome is notable for an increased risk of breast, thyroid and uterine cancer. The disorder is also associated with small, noncancerous skin growths, colon polyps, as well as benign physical features. Screening is offered for prevention of cancer.
Hereditary diffuse gastric cancer is an inherited condition that raises the risk of diffuse gastric (stomach) cancer and lobular breast cancer. The condition is associated with a mutation in the CDH1 gene. Individuals with this syndrome require close medical supervision.
Familial adenomatous polyposis (FAP) is a condition characterized by the formation of as many as several thousand precancerous polyps (called adenomas) in the colon. These polyps significantly raise the risk of colorectal cancer as well as other types of cancer. FAP is associated with mutations in the APC gene.
Li-Fraumeni syndrome is a rare condition associated with a hereditary mutation in the TP53 gene. People with this condition are more susceptible to developing multiple cancers including sarcomas, breast cancer, leukemia, lung cancer, brain tumors and adrenocortical cancer. Individuals with this syndrome are offered an intensive screening protocol.
MUTYH-related polyposis (MAP) is a condition that can cause dozens of polyps to form in the colon and increase the risk of colon cancer. Individuals with an MUTYH mutation are offered increased screening for colon cancer.
Multiple endocrine neoplasia is a group of disorders that causes tumors in hormone-producing glands. Type 1 can involve tumors of the parathyroid or pituitary gland as well as neuroendocrine tumors of the pancreas. Type 2 causes a form of thyroid cancer called medullary thyroid carcinoma. Mutations in the MEN1, RET and other genes can cause multiple endocrine neoplasia. A specialized approach to cancer screening and prevention is recommended.
Von Hippel-Lindau syndrome, which is associated with mutations in the VHL gene, is an inherited disorder that is characterized by the abnormal growth of blood vessels. These growths in blood vessels, called angiomas or hemangiomas, can develop in the retina of the eye, the brain, spinal cord or other parts of the nervous system. People with VHL also have an increased risk of developing kidney cancer and pheochromocytoma, which is a tumor of the adrenal gland. A tailored screening protocol is recommended for VHL patients.
Hereditary leiomyomatosis and renal cell cancer, which is associated with FH gene mutations, is associated with fibroid skin tumors, uterine fibroids and kidney cancers. An intensive kidney and skin surveillance plan is offered for individuals this condition.
Birt-Hogg-Dubé syndrome (BHD) is a hereditary condition associated with benign skin tumors, lung cysts and an increased risk of both benign kidney tumors and kidney cancer. Genetics specialists can help patients stay healthy and manage the condition.
Familial melanoma is suspected when two or three close relatives have melanomas or a family member has multiple melanomas. In some families, a mutation in CDKN2A, CDK4 or BAP1 may be identified, which can lead to improved risk assessment and screening.
Retinoblastoma (Rb) is a malignant tumor of the developing retina that occurs in children, usually before the age of five. Some Rb patients have a heritable predisposition to develop this condition and are at an increased risk of developing non-ocular tumors. Genetic evaluation can lead to future cancer prevention.
Cancer Genetics at the USC Norris Comprehensive Cancer Center includes an expert interdisciplinary team of physicians, genetic counselors and nurses. Our hands-on, personalized approach guides patients every step of the way — including genetic testing, diagnostics and approaches to the prevention and treatment of cancer.
Most Cancer Genetics patients are referred to us by their physician or other healthcare providers. Individuals may make an appointment with the team directly. People who should consider making an appointment with Cancer Genetics usually have one of the following: a personal diagnosis or family member with early onset cancer (usually younger than 50), more than one relative with cancer, have personally had more than one type of cancer or have an unusual or rare cancer.
If a patient or a patient’s family has a strong family history of cancer, we can offer them screening services that can reduce the likelihood of that cancer occurring or allow for early diagnosis. These services will vary depending on the type of cancer, but may involve a combination of screening, medications or risk-reducing surgery. Each patient and family will receive a personalized prevention plan as needed.
Screening for breast cancer includes breast self-exam, clinical breast exam and mammograms. Some women with a family history of breast cancer meet standard guidelines to start screening with mammograms in their 20s or 30s or to screen for breast cancer with MRI. Ask your genetic counselor or nurse if you qualify. Screening for colon cancer is typically done by a colonoscopy screening and is recommended for the general population beginning at age 50. In fact, removing pre-cancerous polyps before cancer develops can prevent colon cancer. Many other cancer screens are available, and a tailored screening approach is developed for each patient and family.
- Prophylactic surgery
For some people, risk-reducing medical therapy or surgery is available and may offer an advantage. For example, bilateral mastectomy can reduce the risk of breast cancer by more than 90 percent in women who carry the BRCA1 and BRCA2 genes. Surgical removal of ovaries and fallopian tubes can reduce the risk of ovarian cancer by 90 percent in women at risk of ovarian cancer. The decision to undertake surgical procedures is a deeply personal one. The Cancer Genetics team can provide counseling and information necessary to help you make the decision.
- Medical treatments
Prevention with medical treatments is also available for some cancers. Oral contraceptives are known to reduce the risk of ovarian and uterine cancers. Tamoxifen and raloxifene (Evista®) have been shown to reduce the risk of breast cancer among women with the BRCA2 mutation by as much as 50 percent over a period of five years. The Cancer Genetics multidisciplinary team can help each patient decide what is best for him or her.
When you call for an appointment with Cancer Genetics, we will arrange for you to meet with a multidisciplinary team of genetic counselors, physicians, nurse practitioners or other experts. In some urgent cases, we can meet with you on the same day.
Your team could include genetic counselors, nurse practitioners and physicians who specialize in genetics and hereditary cancer.
The genetic counselor or nurse practitioner is responsible for taking your family history and facilitating genetic testing. A physician may conduct a physical exam to check for skin findings, thyroid problems or other features of hereditary syndromes. Physical findings, in combination with family history and genetic testing results, can help the team arrive at a diagnosis. Your team will incorporate results from a genetic evaluation into your overall healthcare.
Your first meeting
You may be asked details about your health and your family history with an online questionnaire before your appointment. Counselors will ask you questions about your disease symptoms and why you think you are at risk. They also will ask for details about the health and cancer history of your family members, including your parents, children, siblings and other relatives.
When you arrive at your appointment, your team will evaluate your history and will be able to help you decide whether genetic testing would be beneficial to you. In some cases, they may recommend that your family members consider genetic testing.
There are several ways to connect with Cancer Genetics at the USC Norris Comprehensive Cancer Center. Any patient can phone for an appointment.
Our clinics include:
- Cancer Genetics Clinic — staffed with physicians with expertise in cancer genetics. This appointment includes a team approach to your case with a physician and a genetic counselor or nurse practitioner.
- Lynne Cohen Clinic — this multidisciplinary clinic is dedicated to the prevention of women’s cancers and is staffed by genetic counselors, a breast surgeon, a gynecologic oncologist and a breast oncologist. It is open every other Wednesday.
Genetic testing is performed by a blood test, and your results will typically take three to four weeks to come back. Almost all insurance companies cover the cost of genetic testing when it is recommended by your USC Genetics team. Testing is sent to outside laboratories. Your insurance will be verified by the lab before any testing is started. If testing is not covered by your insurance plan, we may have research opportunities for which you may be eligible.
While genetic test results are typically given by phone for patient convenience, we offer follow up appointments in-person for a detailed discussion of the results. Your dedicated team will determine the most appropriate course of action to help keep you and your family healthy. Preventive strategies to address your risk of cancer will be developed.
Follow-up and education
The counselors and specialists on your team will assist with determining any further preventive procedures, as well as any treatments for existing conditions. The team will help you make informed choices about cancer prevention and your care.
Taking care of your family members
Regardless of your genetic test results, our goal is to keep your family healthy. If a mutation is found, we will facilitate testing for your relatives and help to make sure you can communicate the result with your family. For your relatives who live in other locations, we facilitate referrals to genetics centers in the United States and internationally. We try to ensure that you are able to communicate information to the relatives who need it the most.
If a mutation is not found, we can offer preventive screening tips for your relatives and can connect them with screening services available at Keck Medicine of USC.
As part of an academic medical center, the USC Norris Comprehensive Cancer Center’s Cancer Genetics team at Keck Medicine of USC in Los Angeles provides the latest in diagnostics, treatments and prevention services, but also one of the nation’s widest range of resources for patient support and education.
Registry and clinical research
Participating in research is a valuable way for patients to get exposure to the latest advances in genetic testing. Patients help to contribute to the understanding of genetic susceptibility to cancer and how genetic testing can make a difference to patients’ overall health care. We truly value the contribution of our patients to furthering research at USC.
A number of patient support groups for cancer patients and families are located throughout USC. Each group will depend on the nature of the cancer. Our team can assist patients in finding the right group.
In addition, a number of national and international organizations provide valuable education and support:
Facing Our Risk of Cancer Empowered (FORCE)
Young Survival Coalition
Lynch Syndrome International
No Stomach for Cancer
National Ovarian Cancer Coalition
Foundation for Women’s Cancers
National Cancer Institute
American Cancer Society
National Society of Genetic Counselors
National Comprehensive Cancer Network (registration required)
Jacob Comeaux, MS, LGC
Julie Culver, MS, LCGC, CCRP
Josie Kagey, MS, LCGC
Charite Ricker, MS, LCGC