Hereditary Risk for Cancer

• Expertise: We are the most experienced hereditary cancer team in the D.C. metro area—our doctors and researchers are nationally recognized, and our genetic counselors are certified by the American Board of Genetic Counseling. Such expertise is important, because:

  • Hereditary cancer is a complex, rapidly evolving field—studies show that doctors who don’t specialize in the subject often order the wrong tests or don’t interpret them correctly.

  • Most at-home genetic testing kits (direct-to-consumer, or DTC) don’t look for clinically important genes, and none come with the counseling that can ease anxiety, provide meaning and help guide care, including preventive steps.

• Research and Clinical Trials: We are leaders in local, national, and international research efforts to understand cancer risks associated with gene mutations and cancer family histories; evaluate genetic counseling approaches; help people make decisions about management after genetic testing; identify additional inherited mutations that can cause cancer; and to find better ways to detect, treat, and prevent hereditary cancers.

  • Through Georgetown Lombardi Comprehensive Cancer Center’s Fisher Center for Hereditary Cancer and Clinical Genomics Research, the Lombardi Research Participant Registry, and the MedStar Georgetown Cancer Institute, we are able to provide you with information about many research opportunities. You may benefit by:

    • Getting access to local and national clinical trials that test new approaches to genetic counseling, cancer screening, and cancer risk management

    • Helping the next generation of your family

• Seamless Care: We work closely with MedStar Georgetown Cancer Institute cancer specialists covering all types of cancer. While those doctors know when to send us patients, we also encourage you to contact us. We work with doctors outside the network, too, sharing results and collaborating on management plans.

• Insurance Coverage for Genetic Testing and Counseling: Most insurance companies cover all or part of genetic counseling. For testing, we work with your insurer to get approval beforehand (pre-authorization).

• Confirmed history of a harmful alteration (mutation) in a cancer risk gene

• One or more individuals with cancer diagnosed before age 50, such as:

  • Breast cancer in women: Triple negative breast cancer diagnosed before age 60 (these are breast cancers that are negative for estrogen and progesterone receptors and HER2/neu)

  • Colon cancer

  • Uterine or endometrial cancer

  • Gastric cancer, especially diffuse type

  • Pancreatic cancer

  • Renal cancer

  • Sarcoma of bone or muscle




• One or more individuals who have had any of these cancers:

  • Ovarian, fallopian tube, or peritoneal cancer

  • Male breast cancer

  • Medullary thyroid cancer

  • Sebaceous carcinoma

  • Adrenocortical cancer

  • Choroid plexus cancer




• More than one cancer in the same person, especially if the first one was diagnosed before age 50, such as:

  • Breast and ovarian cancer

  • Breast and thyroid cancer

  • Colon and uterine cancer

  • Melanomas




• One or more individuals with multiple colon polyps (adenomatous, hamartomatous, or juvenile)

• Individuals with the same or related cancers on the same side of the family, such as:

  • Breast, ovarian, prostate, and/or pancreatic cancers

  • Colon, uterine, ovarian, and/or stomach cancers




• Abnormal testing results from colon or uterine tumors

  • These tests are called microsatellite instability, or MSI, and immunohistochemistry, or IHC

  • Abnormal results may indicate an increased hereditary risk




• Jewish ancestry, especially with a personal or family history of breast, ovarian, or pancreatic cancer

• Take a complete personal and family medical history—particularly for brothers, sisters, parents, children, grandparents, aunts, uncles, nieces, nephews, and first cousins—focusing on cancer diagnoses in the family and the age when family members were diagnosed
• Explain how harmful gene changes (mutations) may be passed down in families and contribute to cancer risk, along with other factors
• Discuss options for genetic testing, including the potential benefits, risks, and limitations of testing
• Assess the chance that cancer will develop at some point in your life, or your chance of developing a second (primary) cancer
• Create a personalized plan for cancer screening and risk reduction based on national guidelines and current research
• Review the likelihood that relatives may have an inherited cancer risk mutation
• Refer you to research and clinical trial opportunities
• Provide emotional support and referrals to support groups
• Review previous cancer genetic test results and identify possible new options for testing

• Impact: Most people who get genetic testing cope very well with the results. You may be relieved and feel good about taking action to protect your health and become more informed.  But sometimes coping with genetic test results can be challenging.  We provide information and support resources to help meet your individual needs.
• Family: Obtaining information for family members is often a key reason for choosing to have genetic testing. But sometimes relationships can be strained by prospects of testing and by the results—not everyone wants to know this type of information.
• Uncertainty: Sometimes genetic testing fails to provide a definitive answer about cancer risk.
  • This can happen when extensive testing is pursued and no mutation is found. This type of test result does not always rule out hereditary risks for cancer.
  • Sometimes a gene change is found and the cancer risks that are associated with it are very unclear.


• Timing: The length of time to receive results varies depending on the type of test and the lab used. Sometimes results take several weeks to obtain.
• Cost: The cost of genetic testing varies widely depending on what tests are ordered, what lab is used, and whether you have insurance.
• Genetic Discrimination: The federal Affordable Care Act and the Genetic Information Nondiscrimination Act (GINA), as well as some state laws, provide many protections against employers and health insurers treating people differently based on genetic information.

If you do choose to get tested, we will help you to thoroughly understand the results, their meaning and their implications for you and your family.

• We will give you a detailed written report summarizing your genetic counseling session, the interpretation of any genetic testing results, the recommendations for your medical management, and implications for your relatives

• We will also make specific referrals for medical and other follow-ups, if needed

• Earlier and more frequent cancer screening than people at average risk, sometimes with specific tests
• Use of medications (for example, tamoxifen) to prevent cancer (called chemoprevention)
• Preventative surgery (risk-reducing or prophylactic procedures) to remove the breast(s), the colon, or the ovaries and fallopian tubes
• If appropriate, lifestyle changes such as changing your diet, limiting alcohol consumption, getting more exercise, or giving up smoking