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|CANCER & TREATMENTS FOR CANCER CENTER PATIENTS PREVENTION & RISK ASSESSMENT CLINICAL TRIALS & RESEARCH LIVING WITH CANCER|
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Michigan Oncology Journal Spring 2000
Advancements in Clinical and Basic Science Research from the University of Michigan Comprehensive Cancer Center
Contents:From the Editor
EditorLaurence H. Baker, D.O.
Deputy Director and
Director for Clinical Research
U-M Comprehensive Cancer Center
Assistant EditorMaria McKinney White
Marketing and Public Relations
From the EditorOn a recent Thursday afternoon, a well-educated couple asked an important question in the Cancer Genetics Clinic at the University of Michigan. "Do you think a gene test would give us any information that would help protect our children from colon cancer?" asked the 62-year-old college professor. He had been diagnosed with colon cancer five years ago but now showed no signs of the disease. Other family members had not been so fortunate; his mother and four of her siblings had died of cancer, including one uncle who died of colon cancer at age 42.
The appointment resulted from a referral by the patient's physician, who recognized that his patient's diagnosis and his family history might be related to a specific type of inherited susceptibility to colon cancer. He recommended that this couple consider genetic counseling to help determine whether their children might be at high risk of developing cancer.
Dr. Stephen Gruber, an oncologist and geneticist who directs the Cancer Genetics Clinic, explained to the couple that several possibilities might account for the clustering of cancer in this family, and genetic testing was available. Given the types of cancer in the family and the relatively young age at diagnosis of some family members, Dr. Gruber suspected that Hereditary NonPolyposis Colorectal Cancer (HNPCC) was the most likely explanation.
After considering issues regarding genetic privacy, the cost of testing, the possibility that some family members may not wish to take advantage of this information due to concerns about potential insurance discrimination, and the technical limitations of finding alterations that predispose to cancer, the couple elected to proceed. A tumor test confirmed the professor's cancer had the "molecular fingerprint" of HNPCC, and a blood test identified a mutation that was clearly responsible for HNPCC in this family.
The couple appeared relieved to have a better understanding of the clustering of cancers in their family. As they left the office that day, the professor turned to Dr. Gruber and said, "Even though screening may not be perfect, we wanted to give our children all the tools we could to help them avoid cancer. This has all been helpful, and thank you for giving us information to help protect our children."
Examples such as this emphasize the significant impact of genetics in cancer prevention and care. Colorectal cancer, along with cancer of the breast and prostate, are among the most common cancers in the United States, and the causes for the majority of these cancers still are not known. Among a range of risk factors, hereditary contributions are the best understood, and recent advances in cancer genetics have been translated into new strategies for caring for families with these types of cancer.
In this issue of the Michigan Oncology Journal, Dr. Eric Fearon provides us with a primer on the genetics and molecular biology of colorectal cancer; Dr. Sofia Merajver and Kara Milliron, a genetic counselor, explain the role of breast cancer genetics in clinical practice; and Dr. Kathleen Cooney updates us on recent advances in our understanding of inherited predisposition to prostate cancer. Clearly, we are beginning to unravel the genetic mysteries of cancer, which undoubtedly will lead to better preventive strategies and more tailored, less toxic therapies.
Laurence H. Baker, D.O.
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