Up to 10 percent of certain cancers cluster in families and have a heritable basis. Many individuals fear that cancer may run in their family, but for a variety of reasons they are often reluctant to seek genetic counseling and testing. Because awareness and understanding of their own cancer risk can motivate individuals to seek regular medical surveillance (such as annual mammography, breast self-examination, and regular check-ups) at earlier ages and more consistently, state-of-the-art hereditary cancer risk testing, accompanied by skilled counseling and comprehensive education, has become a mainstream clinical service in cancer medicine. These services, conducted in a professional, multidisciplinary manner, can lead to cancer prevention, early detection, and ultimately, to saved lives.

The UCSF Cancer Risk Program, part of the UCSF Helen Diller Family Comprehensive Cancer Center, identifies families and individuals at high risk for colorectal, breast, ovarian, and prostate cancer by analysis of the family cancer pedigree, assessment of heritable risk, and testing for specific genetic mutations. The 26 members of the program provide professional service to clients, educate the community and health professionals about hereditary cancer risk, and conduct research on cancer risk and prevention.

Because the discovery of genetic susceptibility mutations is recent, many physicians have not had the opportunity to learn how to identify families at risk. Physician education improves doctors' ability to select and refer patients who are truly of heightened susceptibility to cancer and provides additional opportunities for cancer prevention and control, as cancer detected at its earliest stages can be cured.

Clinical Services
In its clinical component, the UCSF Cancer Risk Program is the largest genetic testing center for cancer susceptibility in Northern California. Genetic counselors first consult with concerned families to assess the likelihood of genetic susceptibility and to help family members understand the meaning of a genetic test. They verify the family pedigree and interpret the genetic test results in concert with consultant and referring physicians. Counselors provide an individualized risk-management program for each client that includes detailed recommendations for preventive measures and follow-up. All information is confidential, and clients are encouraged to share information with other family members. A proportion of clients already have cancer or are cancer survivors, while others are unaffected by cancer but may be at increased risk. Thus, each patient has a unique set of concerns: detection of cancer recurrence; early cancer detection; cancer risk for themselves and/or other family members; decisions about prophylactic surgery; and preventive lifestyle techniques.

The program also offers free community and physician educational seminars that give attendees a better understanding of the genetics of heredity; provide the knowledge to learn actual risk (versus perceived risk) of hereditary cancer; and enable physicians to make informed referrals.

Among its key services, the program:

• Identifies, assesses, and supports families and individuals at high risk for colorectal, breast, ovarian, and prostate cancer
• Tests for the presence of genetic mutations in high-penetrance genes for colorectal, breast, and ovarian cancer;
• Identifies rare mutations that cause familial cancer;
• Banks DNA from all clients in search of the discovery of additional genes or polymorphisms that predispose to cancer;
• Offers community educational seminars targeted to the lay public, cancer patients, and health professionals who might not otherwise have this information.

Since its inception, the program has continued to grow to accommodate increasing patient demand for genetic counseling and clinical prevention services and has reached many milestones:

• The program has counseled more than 2,500 individuals and has genotyped more than 1,000 patients.
• A satellite service at the Sacramento Cancer Center has been opened.
• A grant from the Avon Foundation has enabled the program to extend its genetic counseling and testing to underserved women at San Francisco General Hospital Medical Center. Now in its third year of operation, the program at SFGH has provided counseling to more than 250 families.
• Members of the Cancer Risk team have published over 30 research papers and have presented research results at seven national and international meetings.

Leadership
Among the leaders of the Cancer Risk effort are Beth Crawford, MS, CGC, Director of Clinical Services; Jonathan Terdiman, MD, Director of Colon Cancer Registry; and Jane McLennan, MD, PhD, Research and Database Director.

For More Information
Clinical services of the Cancer Risk Program are offered through the UCSF Medical Center. ( > details on the program ) Information is also available about the Prostate Cancer Risk and Prevention Clinic.