DNA Expert Helps Make the Cancer Connections

You inherited your eye color from your mom and your hair color from your dad. Did one of them give you an elevated risk of cancer, too?

That question can now be answered through a new genetic counseling and testing service available at NorthBay Healthcare. Karen Vikstrom, who has more than 15 years of experience in genetic counseling, recently began offering this cutting-edge technology to patients at risk through the NorthBay Cancer Center.

"What we know about genes and their connection to cancer has exploded in recent years,” Vikstrom explained. “The first breast cancer gene, called BRCA1, was identified in 1994 and we now know there are dozens of genes that potentially cause breast and other cancers. In those 5 percent to 10 percent of individuals diagnosed with cancer, there is an inherited factor that we can often identify, and this leads to better treatment and management.”

Access to this innovative service aligns with NorthBay’s mission of providing advanced medicine close to home. Previously, patients who warranted genetic testing and counseling  had to go to San Francisco or Sacramento, noted Teresa Langley, assistant vice president, Oncology.

“Karen’s expertise strengthens our strategic initiatives of Seamless Care, Trust, and Independence,” Teresa said. “Her genetic counseling skills give patients the opportunity to have personalized treatment options right here, close to home.”

Any NorthBay Healthcare physician — whether an oncologist, specialist or primary care physician — can refer a patient with certain red flags to Vikstrom for a genetic risk evaluation.

Those red flags crop up when capturing a patient’s medical and family history, she explained. For breast cancer, the three most common red flags are if a woman is diagnosed as having breast cancer before the age of 50, if several members of the same generation have been diagnosed with breast cancer, or if it runs in several generations. Women with ovarian cancer at any age should also be evaluated.

Other red flags include a diagnosis of any cancer in anyone under age 50 or more than one cancer in the same person. A pattern of cancers may also be of concern, as researchers now know that some breast and ovarian cancer genes may also cause prostate and pancreatic cancer and melanoma. And a family history of colon cancers may point to another hereditary condition — Lynch Syndrome — a condition that increases the risk of cancers of the uterus, stomach, ovaries, small bowel, pancreas, urinary tract, kidney and bile ducts, and a slightly increased risk of prostate cancer.

Physicians who believe their patients may be at risk can have them fill out a questionnaire that is forwarded to Vikstrom. If the information warrants further investigation, the patient meets with her for a cancer risk assessment. She works with the patient to create an even more detailed, three- to four-generation medical pedigree. If genetic testing is indicated, a saliva or blood sample is collected and sent for analysis.

“It’s like detective work,” she explained. “I ask lots of questions, about every individual in the family — those with cancer and those without.”

Test results are usually available in two to three weeks. She interprets the results and meets with the patient to discuss next steps.

A patient can be self-referred or referred by their physician, Vikstrom explained. Genetic counseling may be covered by insurance — including Medicaid — if specific criteria is met. Insurance authorization will be obtained for all patients before they are scheduled for an appointment. If their insurance does not cover the service, Vikstrom can explain other testing options, which often include low-cost, out-of-pocket tests.

Patient privacy is paramount and protected by laws, Vikstrom explained. The Genetic Information Nondiscrimination Act of 2008 (GINA) prevents employers and health insurance companies from using a person’s genetic information in employment or coverage decisions. This law does not cover life insurance, disability insurance, or long-term care insurance.

And, the results of the test are also protected under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA requires that providers, such as doctors, nurses, and hospitals, keep your health information private.

Any NorthBay Healthcare physician or clinician is welcome to contact Karen for copies of the Cancer Risk Assessment questionnaire, or for questions. She can be reached at (707) 624-8000.

“If we can identify people with higher-than-average cancer risks, we can implement a screening plan and hopefully prevent cancer or catch the disease early, when it is highly treatable.”