Cancer was the second leading cause of death in the United States in 2013 and the American Cancer Society expects almost 10,000 new cases in New Mexico this year. But statistics like these can't answer personal cancer questions. "A lot of patients will come to me wanting to know: what's my chance of developing cancer, based on my family history?" says Shawnia Ryan, MS, CGC. Ryan helps them find the answer.
Ryan's experience includes prenatal and pediatric genetics. She joined the University of New Mexico Cancer Center last August to focus on cancer genetics. "Many areas in genetics, overall, are changing rapidly," she says. "I felt like I wanted and needed to specialize in order to make sure I was serving the patients in the best way."
Ryan is the second certified cancer genetic counselor in the state and works closely with Lori Ballinger, MS, CGC, at UNM Cancer Center. Ballinger is the other certified cancer genetics counselor in New Mexico. They stay very busy with following genetic research in cancer and with helping their patients make sense of genetics and statistics.
Two of the biggest challenges in getting helpful genetic information is deciding who to test and what to test for. "Genetics is not isolated to one individual," says Ryan. "It's the whole family. It may be that you're not the best person to test because you haven't had cancer." Genetically testing family members who have been diagnosed with cancer may give the entire family the most information. It may also help those family members.
But sharing the results of genetic testing is not as easy as it sounds. "We can't just share family information without consent," says Ryan. She and Ballinger follow a strict process at UNM Cancer Center to respect family members' privacy. Their process helps them to make sure they have the correct person's permission, in writing, before sharing any test results or other information.
The other big challenge is choosing which genes to test from the vast array of possible genes. For example, most people have heard of BRCA1 and BRCA2, two genes linked to breast cancer and ovarian cancer. But Ryan says, "We have a variety of different genes that can predispose to breast cancer."
Many genes can increase someone's risk of colon cancer, too. Choosing the right genes to test might require information from other tests. "We would look at what types of [colon] polyps, how many polyps, and if testing is appropriate, which genes to test," says Ryan. "It's a team approach between the genetic counselors, the treating doctors and the pathologists."
The team includes the patient as well. Cancer genetic counselors pull information from many sources. They help people to make sense of the medical information, the statistics and the genetics. But ultimately, the person who asked the initial cancer question must decide what to do. "It's not so much an informed consent process," says Ryan. "We view the genetic counseling process as an informed decision-making process."