Patient Management

Review each patient’s past medical history, family history, and ancestry. Update the paternal and maternal family cancer history every one to two years, since family history is not static. Ask about cancers (location and site) through their grandparent’s generation and ages at diagnosis and death.

If appropriate, refer to a genetic counselor (or equally trained genetic professional) to—

• Discuss the risks, benefits, and limitations of appropriate genetic tests.
• Consider and/or obtain genetic testing.
• Interpret genetic test results.
• Discuss options for early cancer detection and risk reduction.

Communicating with Patients and Families

Individuals with genetic conditions can be stigmatized. Patients may fear personal or insurance discrimination. The Genetic Information Nondiscrimination Act (GINA) of 2008, a federal law, prohibits discrimination in health coverage and employment on the basis of genetic information. However, its protections do not extend to life insurance, disability insurance, and long-term care insurance.¹

Patients may feel guilty about the possibility of passing on the gene or about not inheriting the gene when siblings are affected (survivor guilt). Emotions related to genetic conditions can affect the entire family. Primary health care providers can partner with a genetic counselor to navigate these issues.

Reference

¹Department of Health and Human Services. “GINA” The Genetic Information Nondiscrimination Act of 2008: Information for Researchers and Health Care Professionals. [PDF-38KB]