A Question of Family—and Cancer

The Familial Cancer Program counsels families on the risks of inherited cancers.

Family gatherings bring the legacy of generations into sharp focus—the accomplishments, the experiences, the memories, the old stories, and the imprints of genetics. We are reminded, poignantly, of our connectedness to those who came before us and those who will come after.

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In certain instances, genetic mutations can be inherited by multiple generations. Thanks to the Familial Cancer Program, people at risk of having such a mutation can be tested.

Such reunions can also bring forth difficult questions. Why do certain kinds of cancers seem to appear generation to generation in certain families? Which families are at risk for which cancers?

The Familial Cancer Program at Norris Cotton Cancer Center provides counseling for people who may have an increased risk of cancer because of their personal and/or family history. The program offers family history analysis, risk assessment, screening and prevention recommendations, genetic counseling, and genetic testing. "We're the only cancer genetics service in New Hampshire," says Bradley Arrick, MD, PhD, co-founder and director of the program. Besides the services it provides at Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center in Lebanon, NH, the Familial Cancer Program also provides services at the Cancer Center's regional locations in Manchester, NH, and St. Johnsbury, VT.

Can Cancer Run in Families?

Should you consider genetic counseling? Ask yourself these questions:

  • Have several members of your family been affected by cancer?
  • Has cancer occurred at an unusually young age in your family?
  • Has someone in your family had multiple cancers?
  • Are there unusual types of cancer in your family?

If your answer to any of these questions is "yes," you may wish to consider cancer risk assessment counseling. Cancer survivors who are concerned that they have inherited an increased risk of cancer may also benefit from counseling regarding their risk of a second cancer.

How Cancer is Passed Down

Certain genetic mutations can make people more susceptible to cancer. For example, some genes—called tumor suppressor genes—suppress the formation or growth of tumors. When a mutation changes a tumor suppressor gene, that alteration can increase the risk of cancer. In certain instances, those mutations can be inherited by multiple generations. Thanks to the Familial Cancer Program, people at risk of having such a mutation can be tested.

If You Have a Family History of Cancer

The program also offers counseling for people whose genes indicate an increased risk of cancer. To help patients decide which treatment is best for them, Arrick has worked on finding innovative and effective methods of talking to patients about their options. "We are focused on trying to look at different ways to convey numerical information," he says. He has found that the use of visual aids makes it easier for people to understand their risks and make informed choices about their treatment.

How to Reduce your Risk of Cancer

Most cancers, however, are not inherited. They occur by chance or are caused by exposure to cancer-causing material, such as tobacco smoke. Also, some types of cancer are common. Just because someone in your family has had cancer does not necessarily mean you or another family member will inherit cancer.

But having a genetic test from the Familial Cancer Program can provide a nice assurance. Arrick says that regardless of the outcome, genetic testing provides significant benefits for patients and families. "If they end up testing positive, then we can design a program of prevention and screening and really save them from cancer or catch it in its earliest stages," he says. "And if they're negative, we can give them quite a sense of relief."

November 23, 2011