The future of cancer medicine relies on information about a patient’s unique genetic makeup and the composition of his or her specific cancer. This information is extremely helpful in selecting the best treatments for targeting specific genes and proteins responsible for cancer cell growth. Sentara continues to focus on precision medicine as a means to offer a more personalized and effective approach to cancer treatments.
In 2017, the Sentara molecular testing laboratory implemented next-generation molecular sequencing to analyze multiple genes faster and more cost-effectively. The test evaluates 50 genes that are known to affect tumor growth and treatment response. Using the results, oncologists tailor chemotherapy to target the unique genomic makeup of a patient’s tumor.
Our on-site, board-certified molecular genetic pathologist ensures our doctors get critical test results within one week (compared to two to three weeks with an off-site lab). This fast turnaround allows patients to start appropriate treatment sooner. Nine out of 12 Sentara hospitals were using the on-site lab in 2017.
Also in 2017, the lab began automatically testing for gene mutations in patients whose lab results indicate non-small cell lung cancer. This process allows oncologists to develop a treatment plan based on the lab findings and have it ready when they meet with a patient to give the diagnosis.
We continue to look to the future by preserving patients’ biopsied tissue samples in formalin-fixed paraffin. Should a patient need additional tests, we can use the preserved tissue instead of conducting another biopsy. With multigene sequencing, we can test for more gene mutations using less tissue. Researchers also utilize archived tissue samples for use in studies.
A genetic counselor worked with a team of breast cancer specialists at Sentara Martha Jefferson Cancer Center on developing a high-risk breast cancer program throughout 2017, which went into effect at the start of 2018. The program uses information gleaned from mammogram screenings, personal histories and questionnaires to identify women who could have a higher risk for breast cancer. Women whose lifetime risk of breast cancer is 20 percent or higher receive a mailed letter asking them to contact the high risk breast program.
Following another risk assessment test via phone, appropriate patients are referred to the program for follow-up. Blood tests can screen for up to 46 genetic mutations linked to breast cancer, including BRCA 1/2. The goal is to identify women who might benefit from more frequent and/or additional screenings such as breast magnetic resonance imaging (MRI). Sentara RMH Medical Center also has a high risk breast program, and both programs continue to work together on best practices.
In addition to breast cancer, genetic counselors advise patients and loved ones who have a higher risk of hereditary cancers such as ovarian, uterine, colorectal, prostate and pancreatic. While genetic tests are helpful, inherited gene mutations are responsible for only 5 to 10 percent of all cancers.
When needed, genetic counselors partner with psychologists and social workers to connect patients and family members with appropriate counseling resources.