Patients in Orlando, Fla. who are at high risk for cancer now have access to a specialized center with a dedicated oncologist, nurse practitioner and genetic counselor to assist them with their unique healthcare needs. The Cancer Genetics Center at UF Health Cancer Center -- Orlando Health, the first and only one of its kind in Central Florida, is a comprehensive center that will serve patients to not only assess their risk for genetic cancer but also assess their risk for acquired cancer.
"We will offer one-stop shopping in terms of having a genetic-focused physical exam, a thorough comprehensive counseling session, and then providing those patients with, depending on the findings, what their appropriate pathways should be, either for intervention, prevention, surveillance or lifestyle changes," said Rebecca Moroose, MD, Medical Director of the Cancer Genetics Center.
Led by Moroose, nurse practitioner Deborah Nosotti, ARNP, and genetic counselor Ryan Bisson, the Cancer Genetics Center focuses on educating and supporting patients through genetic counseling and will extend to genetic testing if necessary.
A board certified genetic counselor, such as Bisson, will analyze the patient's personal and family history, various risk models and determine the patient's risk of carrying an inborn (germline) mutation that can increase cancer risk above the average rate for the population. Based on the patient's goals and the calculated risk a shared decision will be made whether to pursue testing and what specific genes should be tested.
"Most cancer is not hereditary and therefore genetic testing is usually not needed," said Bisson. "Our center is able to obtain and analyze the personal and family history in order to determine if genetic testing is appropriate for each patient."
With the advent of the human genome project, and being able to map the entire human genome, Moroose said that more cancer genes have been discovered, studied scientifically, interrogated with family information, and then have ultimately shown to be markers of an increased susceptibility to different cancers.
"There are now over 90 different hereditary cancer syndromes," she said. "In addition, with new genes we are learning about almost monthly, it's difficult for the general physician, physician assistant or nurse practitioner to keep up with all of that. That is why a qualified, certified genetic counselor is the real focus of our center. Clinicians who understand the physical manifestations of cancer genetic syndromes are also important. They understand the guidelines in terms of what happens if you find a patient with a cancer-predisposing mutation--how should that patient be followed and what should be offered to him or her."
According to Bisson, there are many genes associated with hereditary forms of cancer. With new technology, there are many genetic testing options that are difficult to keep up to date with unless your specialty is cancer genetics.
"Our center is able to provide the pros and cons of each testing option to patients that are interested in pursuing genetic testing," he said. "The most appropriate relative to undergo genetic testing is usually a relative with a personal history of cancer. During a genetic counseling appointment with our center, we are able to determine which family member is the most appropriate person to initially undergo testing."
Along with genetic testing and counseling, Nosotti added that the center also offers comprehensive care for patients at high risk for breast cancer based on personal and family factors.
"This includes increased surveillance and risk reduction through lifestyle and medication," she said. "The Cancer Genetics Center was developed to offer genetic counseling and testing for patients who may be at risk for cancer due to a genetic mutation. The evaluation of risk is based on personal and family factors and follows the NCCN guidelines."
To help its members improve their well-being, health insurance companies like Cigna and United Healthcare are encouraging genetics testing at qualified centers.
"Last year Cigna, the health insurance carrier, required that any patient undergoing genetic testing be seen by a board certified genetics counselor," said Moroose. "In January 2016, United Healthcare will join on board. Cigna's pilot project last year showed millions of dollars in savings if genetic counseling and testing was done in a qualified center. Patients got more accurate testing in terms of testing for the right genes, while patients who did not require testing did not have this very expensive testing done."
Moroose expects the center to benefit the local community because it offers genetics counseling and testing to anyone in the community regardless of where their medical care is delivered.
"When we get our findings and recommendations, we send a roadmap to their primary care physician or referring physician," she said. "We also offer to patients who may not have a doctor who is comfortable in monitoring them, especially if they were found to have serious mutations, a place where they can come and be scheduled, followed and monitored appropriately. We also help patients facilitate risk-reducing surgeries and other risk-reducing strategies."
In 2016, the center will be launching a web based software that can really help patients compile their family history of cancer, called Their Cancer Pedigree. If the patient agrees, the software will be able to transmit the data to institutions in the state and nationally collaborating in genetics registries.
"The Cancer Genetics Center will be doing research with University of Florida, City of Hope, Moffitt Cancer Center, and other institutions to continue to search for important genetic alterations that inform us about cancer risk," said Moroose. "This will also make it easier for patients to do their preliminary work which is so important for us to analyze when we decide what panel of genes or what types of genes that we need to test if testing is appropriate."
Further down the road, Moroose said they will look at opportunities with collaboration with the University of Florida Gainesville to provide resources for training and outreach.
"This is part of our loftier goal to be accomplished in the next calendar year but could be accomplished for something later in the future," she added.
Patients can be referred to the Cancer Genetics Center by their physician or do a self-referral. Interested patients will complete a health inventory and genetics questionnaire and then have an appointment scheduled. The initial visit will take approximately 2 to 2 1/2 hours.
For more information, visit www.ufhealthcancerorlando.com.
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