UCLA Hereditary Cancer Risk Program

Most cancers are not due to an inherited predisposition. However, your personal and/or family history may mean that you have an increased risk for cancer. Our cancer genetic counselors offer personalized risk assessment to help you and your family members be proactive with your health. If you are found to be at higher risk to develop cancer based on family history and/or the presence of a harmful inherited genetic variant, also known as a mutation, we will recommend individualized changes to your medical care to manage and reduce those risks.

Determining your risk

When there are multiple cases of colon cancer in a family, this may be due to chance, shared environmental factors, known or unknown genes, or a combination of genes and environment. Roughly 5 to 10 percent of colon cancers are hereditary, where the risk is passed in specific versions of genes, from parent to child.

Our board-certified and licensed genetic counselors help you understand these risks. Your genetic makeup alone does not determine whether you will develop cancer. Knowing your risks allows physicians to provide personalized proactive monitoring, prevention strategies and treatment for you and your loved ones.

Who should consider genetic counseling and genetic testing for hereditary cancer?

You may wish to see a genetic counselor if you have:

• Certain types of colon polyps or more polyps than we would expect by chance
  • 10 or more adenomas
  • 2 or more hamartomas
  • Any number of Peutz-Jegher type polyps or juvenile polyps
  • 5 or more serrated polyps
  • Several polyps that are a mix of the different types listed above
• Colon cancer or other gastrointestinal cancer diagnosed under the age of 50
• Screening or genetic testing performed on a tumor that indicates you might have an inherited genetic predisposition
• Colon cancer and one or more primary cancers in other tissues or organs (that did not spread from the same cancer)
• Multiple individual, primary colon cancers
• Bilateral cancer in paired organs (e.g. kidney cancer in both kidneys)
• Clustering of the same or related types of cancer(s) in relatives. For example, multiple relatives on the same side of the family with colon cancer, especially if diagnosed under the age of 50
• Rare tumors or cancers; or a rare tumor type as described by a pathologist in an otherwise common cancer
• Other medical findings such as physical differences, birth defects, unusual birthmarks or skin findings, etc., combined with a family and/or personal history of cancer
• A known mutation in a cancer predisposition gene in a family member
• Certain ethnicity. For example, individuals of Ashkenazi Jewish ancestry are at higher risk to carry inherited mutations in some genes known to increase the risk for cancer
• A confirmed diagnosis of a hereditary cancer syndrome. Even if you met with a genetic counselor years ago, management recommendations change over time as we learn more

Genetic counseling at UCLA

Our genetic counselors can help patients understand their genetic risks by providing them with the following services:

• Personalized genetic risk assessment
  You and your genetic counselor review your personal history, medical records, and family history. Before your first meeting, you will complete a questionnaire about your personal and family history of cancer. We understand that getting this information from relatives may be difficult, but we ask that gather as much information as you can. Knowing the specific kinds of cancer and the ages when your family members were diagnosed allows for the best estimation of your hereditary cancer risk and the most beneficial genetic testing.

  Download our Genetic Risk Assessment Questionnaire

• Genetic testing
  If testing is appropriate and you decide that you want to have it, we can order genetic testing at your genetic risk assessment appointment. Your genetic counselor will discuss the benefits and limitations, as well as the cost and insurance coverage, of genetic testing. Testing is usually done on a blood or saliva sample. Once results are available, your genetic counselor will explain them to you, provide you with copies of your results and discuss the next steps in your care.

• Medical referrals and guidance
  Medical guidelines exist to help healthcare providers monitor patients with certain genetic risks. Your genetic counselor will provide a personalized plan for cancer screening, may offer recommendations for other strategies to reduce your risk of developing cancer, and may provide referrals to specialists based on your unique history and genetic testing results. Our genetic counselors work with other UCLA experts as a team. This helps us streamline your medical care and gives you access to high-caliber monitoring, prevention and treatment at UCLA.

Hereditary cancer syndromes

Several hereditary cancer syndromes increase your risk for colon cancer and other cancer types.

Below are some of the more common hereditary cancer syndromes that increase colon cancer risk.

• Lynch syndrome: Also called hereditary nonpolyposis colorectal cancer (HNPCC), this inherited disorder increases the risk of colon cancer and uterine cancer. Individuals with Lynch syndrome have an increased risk for other cancers including ovary, stomach, small intestine, urinary tract/bladder/kidney, bile duct, pancreas, sebaceous gland, and brain (usually glioblastoma).
• Familial adenomatous polyposis (FAP): Patients with FAP develop hundreds to thousands of precancerous growths in the colon, called adenomatous polyps. Individuals with FAP have an increased risk for other cancers, including stomach, small bowel, pancreas and bile duct, liver, thyroid, and central nervous system (usually medulloblastoma). Some people with FAP have features including stomach and small bowel polyps, and other types of benign growths and tumors.
• MUTYH associated polyposis (MAP): Patients with MAP also develop growths in the colon, called adenomatous polyps (usually 20 to 100), but may develop a single solitary colon cancer at a young age as their first sign of the disorder, without polyps. Unlike most of the genetic conditions that we know increase the risk to develop cancer, MAP is recessive in inheritance. This means that the affected individual is often the first member of their family to be affected, as their unaffected parents each passed on one copy of a non-working MUTYH gene to their affected child.
• Many other genes are known to increase the risk for colon polyps, colon cancer and other cancers. Sometimes, genes associated with other cancer types may present atypically for a particular family. A genetic counselor helps to ensure that the appropriate tests are made available to you and your family.

Insurance and cost

Health insurance almost always covers a genetic counseling consultation and risk assessment. If your personal and/or family history meets certain criteria, genetic testing is covered as well. Your actual out of pocket cost depends on your insurance plan and factors such as unmet deductible and copay. If you have a managed care plan, your doctor may need to request authorization first in order for your appointment to be paid by insurance. The cost of genetic testing has dropped significantly in recent years. We will discuss testing options, insurance coverage, and costs with you in detail during your initial appointment with us.

Contact us

For more information or to make an appointment with a cancer genetic counselor:

• Phone: 310-825-5287
• Email: [email protected]