Clinic to serve patients at high risk of cancer

MedStar Health program include genetic counselors and specialists

Four members of Jackie Dressel’s family have been diagnosed with breast cancer, including her mother, who died of the disease in her mid-30s.

Dressel’s doctor sent her to be tested for well-known genes linked to increased risk for breast and ovarian cancer, and though the tests were negative, she opted for a preventive double mastectomy anyway.

“I didn’t want to live in fear anymore,” said the 30-year-old Towson therapist. “For me, it was a relief.”

MedStar Health, which treated Dressel, is launching a program aimed at patients like her who have a family history of a specific cancer, mutant genes linked to one or more types of cancer, or other factors that could make them more likely to develop tumors. A team that includes specialists and genetic counselors will assess a patient’s need to be screened for cancer-related genes, develop treatment plans that consider current and future risk, and encourage regular diagnostic testing.

The hospital system follows other health providers around the country and locally, including the University of Maryland Medical System and Johns Hopkins Medicine, that have added genetic counselors in various departments or started general high-risk programs like MedStar’s, as more is learned about mutant genes beyond the well-known BRCA mutations associated with breast and ovarian cancer.

Dr. Yvonne Ottaviano is chief of medical oncology at Franklin Square Medical Center, where the MedStar High Risk Assessment and Cancer Prevention Program is based. She said the program intends to offer an extensive educational component for the public and an emphasis on follow-up, normally left to patients. Ottaviano said she “wants to make sure they don’t fall through the cracks.”

She said not everyone with a genetic mutation or family history will need immediate treatment, but many may need to undergo more frequent testing with mammograms, MRIs, colonoscopies, blood tests or other exams. Some may benefit from lifestyle changes, drugs or even surgery such as Dressel’s.

“If you have a mutation, it’s for a lifetime,” Ottaviano said. “You don’t meet someone once and they recommend something, and then you fall off the wagon and don’t go for a mammogram or colonoscopy anymore. And believe me, people fall off the wagon all the time.”

The counselors and doctors in the program will look at conditions and cancers that may give rise to multiple forms of the disease. An inherited condition called Lynch syndrome increases risk of colon and other cancers, for example. And BRCA mutations also can increase risk of prostate cancer.

Doctors and genetic counselors in several other high-risk cancer programs say patients usually are referred by primary care doctors or specialists who diagnosed cancer or learned of a family history of the disease, though some patients contact them directly. Genetic counselors use standard questions to gauge the need for genetic testing, and generally like to narrow their search for mutations by testing a family member who already has a cancer diagnosis.

Only about 10 percent of cancers have a known genetic link, with the majority attributed to a confluence of aging, lifestyle or environment, said Jessica L. Scott, a certified genetic counselor at the University of Maryland’s Marlene and Stewart Greenebaum Cancer Center, which houses a high-risk center specifically for breast cancer and a specialty group for other types of cancer.

Scott said many patients believe that having a family member with cancer means