The goal is to identify patients with Hereditary Breast-Ovarian Cancer (HBOC) and Lynch syndrome, two of the most commonly inherited cancer predisposition syndromes. For those carrying these mutations, the lifetime risk for breast, ovarian, colorectal, and uterine cancer is as high as 85 percent.
“Overall, about 10 percent of cancer diagnoses are hereditary,” said Linda Robinson, Assistant Director of Clinical Cancer Genetics at UT Southwestern. “The power of genetic testing is that we can lessen the amount of treatment for these people by finding the cancer early, and for some patients we can prevent it from happening altogether.”
Cancer Genetic Services for Rural and Underserved Populations in Texas is part of the Genetics Department at the Harold C. Simmons Cancer Center, in partnership with Parkland Memorial Hospital in Dallas and the Moncrief Cancer Institute and JPS Health Network in Fort Worth. The cost of the genetic evaluation and testing is covered through the CPRIT grant and other external funding sources.
“This support from CPRIT is crucial in enabling us to offer genetic counseling to populations who have never received these services,” said Dr. James K.V. Willson, Dean of Oncology Programs, Professor and Director of the Harold C. Simmons Comprehensive Cancer Center, Professor of Internal Medicine, and holder of The Lisa K. Simmons Distinguished Chair in Comprehensive Oncology.
The principal investigator on the grant is Dr. Keith Argenbright, Director of the Moncrief Cancer Institute, Associate Professor at the Harold C. Simmons Cancer Center and Department of Clinical Science, UT Southwestern.
“We now have the ability to connect with patients through telemedicine, a high tech communications system linking patients in outlying counties with our genetic specialists,” said Dr. Argenbright. “With this new grant, we are building on the success of a similar program CPRIT funded three years ago, which brought state-of-the art genetic testing closer to home for our patients.”
The new grant funds the program for an additional three years. The initial $1.6 million CPRIT grant from 2011 included Tarrant, Dallas, Wise, Hood, Johnson, and Parker counties, a population of 3,511,623. The expansion includes a population increase of 1,156,449 and covers an estimated additional 13,480 square miles, more than double the size of Massachusetts. In Texas, 43 percent of the population is uninsured or underinsured. CPRIT funding allows for genetic services for patients who have never had access to these services before.
In the first 20 months, more than 61,000 underserved women were screened for HBOC risk, and more than 500 underserved patients with colon and uterine cancer were tested for Lynch syndrome. About one in 300 people have Lynch syndrome, which is 3 percent of all colon and uterine cancer patients. Lynch syndrome patients have nearly an 80 percent risk of a cancer diagnosis as a result – colon, uterine or ovarian. “Patients with Lynch syndrome who follow the recommended increased surveillance can live 26 years longer,” said Mrs. Robinson.
The additional counties served by UT Southwestern’s expanded genetics program include: Bosque, Clay, Comanche, Cooke, Denton, Ellis, Erath, Hamilton, Hill, Jack, Montague, Navarro, Palo Pinto, Somervell and Young County. Genetic services are new to much of the service area. “In these counties, no one will need to drive more than an hour to receive genetic counseling,” said Mrs. Robinson. For information, call 214-645-2563.
An estimated 72,280 Texas residents carry mutated genes that increase cancer risk. Identifying these individuals can reduce the number of cases and the resulting burden of a cancer diagnosis. “It’s not just about the patient; it’s about identifying cancer risks for the entire family,” said Mrs. Robinson.
Access to such genetic screening services in uninsured, ethnic, and racial minorities or geographically isolated populations is often non-existent. Those at high risk may go unidentified and unmanaged. Genetic counseling through tele-medicine increases accessibility of services while decreasing patient transportation costs, inconvenience, and missed time at work. It addresses barriers to care and helps increase appointment adherence in rural underserved populations.
UT Southwestern is the first and only telemedicine program for genetic cancer screening in Texas. Patients in rural and underserved areas meet with genetic counselors at designated locations using highly secure interactive video services, similar to Skype. Prior to the meeting, the patient can complete an online bilingual family history questionnaire developed at UT Southwestern called Cancer Gene Connect. This risk assessment software can calculate the risk for hereditary cancer. Based on the results and follow up conversations, the counselor may recommend genetic testing to determine whether the patient has a mutation.
The patient’s blood or saliva sample can then be examined for a panel of between 25 and 30 cancer genes, allowing researchers to identify mutations in many types of cancer, including hereditary breast, colon, uterine, and ovarian. Genetic counselors call the patient to discuss their results. Some patients are advised to have additional or more frequent screening, such as annual colonoscopies starting as early as age 25. In some cases of unusually high risk, preventive surgery may be recommended, such as removing the breasts, uterus or ovaries.
Equally important as a complement to genetic counseling and testing are the education components to this program. “Our goal is to get patients and their physicians to understand the importance of this mutation, and the importance of surveillance,” said Mrs. Robinson. Videos with understandable language and graphics can help dispel myths about genetic testing and help patients feel more comfortable with the process.
UT Southwestern’s Harold C. Simmons Cancer Center is the only National Cancer Institute-designated cancer center in North Texas and one of just 66 NCI-designated cancer centers in the nation. The Harold C. Simmons Cancer Center includes 13 major cancer care programs with a focus on treating the whole patient with innovative treatments, while fostering groundbreaking basic research that has the potential to improve patient care and prevention of cancer worldwide. In addition, the Center’s education and training programs support and develop the next generation of cancer researchers and clinicians.
In addition, the Simmons Cancer Center is among only 30 U.S. cancer research centers to be named a National Clinical Trials Network Lead Academic Site, a prestigious new designation by the NCI, and the only Cancer Center in North Texas to be so designated. The designation and associated funding is designed to bolster the cancer center’s clinical cancer research for adults and to provide patients access to cancer research trials sponsored by the NCI, where promising new drugs often are tested.
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
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