How to Fight Cancer Before It Begins

Genetic testing can give patients a big head start
Doctor talks with patient in office

It’s not exactly a crystal ball, but research happening at The University of Vermont Cancer Center offers patients and their loved ones a possible peek into the future.

“We’re really trying to move the needle on how we care for patients, whether it’s improving access to genetic testing or providing better care if someone tests positive,” says Kara Landry, MD, an oncologist and co-director of the Cancer Genetics and Prevention Program at UVM Medical Center.

Assessing the Risk

People who undergo genetic testing are typically anxious to find out if they have inherited a mutation that may increase their risk of cancer. Those who test positive are considered to have a Hereditary Cancer Syndrome (HCS), which means they have a higher risk of developing cancer.

“These genes can play a role in the development of many different types of cancer, and identifying patients at risk is important,” Dr. Landry explains. Genetic testing can be a huge advantage for people who don’t have cancer but do have genes or mutations that put them at risk. It allows them to take more preventative measures or detect cancer earlier when there are more treatment options.

Unfortunately, Dr. Landry says such prevention and surveillance options are currently being underutilized. 

“Studies have shown that colonoscopies or breast imaging are effective in screening for cancer in this high-risk population,” says Dr. Landry. “But we still are not seeing the uptake of those strategies at a rate that we would like.”

In other words, when patients learn through genetic testing that they are at greater risk for cancer, they then don’t monitor for it as they should going forward – effectively eliminating the advantage provided by getting the test.

Dr. Landry is trying to change that behavior.

Building a Medical Home

Dr. Landry and colleagues from the UVM Cancer Center are conducting a study that will look into whether providing a “medical home” for patients with HCS will help them stay healthy. The goal is to help patients navigate what can be a very complicated process – from coordinating countless appointments to answering numerous questions on everything from medications to nutrition and lifestyle changes.

“For example, there’s something called Lynch syndrome,” explains Dr. Landry. “We know these patients are at increased risk for colon cancer, as well as some other types of cancer. But the prevention and screening strategies require complex, multi-disciplinary care that involves a number of specialists,” she explains. “So getting those patients access to the care they need is complicated, and unfortunately, the burden of coordinating that care often falls on the patient or the primary care provider.”

Instead, as part of her research, Dr. Landry along with fellow Medical Oncologist Marc Greenblatt, MD, and a team of genetic counselors, will help coordinate all of the care associated with each participant. Her study, funded by a Clinical Investigator Development Initiative grant from the J. Walter Juckett Cancer Research Foundation, will follow patients identified with HCS for a two-year period as they go through the medical home program.

Dr. Landry explains how it would work. If, for instance, a patient tests positive for a harmful variant in the BRCA1 gene, which could lead to breast cancer, they would meet with Dr. Landry to talk about ideas for prevention and surveillance, including imaging, surgery, physical exams and medications. Dr. Landry would then help order imaging, or refer the patient to meet with a surgeon, or discuss medications and clinical trial options.

“My hope is this will really decrease the distress patients are feeling and eliminate some of the preventable things that can get in the way of following recommended care plans,” Dr. Landry says.

Giving Patients an Edge

Other aspects of genetic testing research interest Dr. Landry as well.

“Even if you already know you have cancer, there are still important reasons to do genetic testing,” she explains. It can provide information that can determine treatment options, and it can help inform whether family members should also be tested to help them catch and treat cancer early as well.

She and her team recently tried out a new approach for counseling patients undergoing genetic testing. Typically, patients must have a counseling session before getting tested. Instead, Dr. Landry and her team provided written information before the test, but only offered counseling if the results came in positive.

The study showed that participants were overwhelmingly satisfied with the streamlined process. In a population already burdened with numerous medical appointments, this new approach may help increase the number of people opting for genetic testing—and help save lives.

“This is just some of the exciting research that is coming directly out of UVM to address current issues with cancer care,” says Dr. Landry. “I have no doubt that the work we’re doing here in our region, right now, will lead to more major advancements in the field of genetic testing. And that will give our patients, and their loved ones, a true advantage.”

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