Interprofessional Collab

Question 1

What are the takeaways when you have a patient with variant of unknown significance has a family history of cancer? x5

Answer 1

1. Personal or close family history of someone diagnosed with breast cancer at or before 50 years old meets NCNN criteria for hereditary breast and ovarian syndrome testing
2. Variant of uncertain significance is not clinically actionable and should not impact management decisions
3. Negative result does not rule out all sources of familial breast cancer risk so high risk breast cancer screening may still be indicated
4. Screening starts 10 years prior to the youngest diagnosis of breast cancer in family
5. Chemopreventatives (ex. Tamoxifen) are only validated for women over 35 year old

Question 2

What are takeaways for testing decisions in a patient with a family history of colon center?

Answer 2

1. Personal or close family history of someone diagnosed with colon cancer before 50 year old meets NCCN criteria for Lynch syndrome genetic testing
2. Best practice is to test affected relatives first but not always great, best to test patient in front of you
3. Comprehensive panel testing or panel testing based on cancer indicated is current best practice - genetic testing should at least cover all conditions related to all cancers seen in family history
4. Genetic testing involves a shared decision making process with provider and patient

Question 3

What are the takeaways of the interpretation of prenatal screening results?

Answer 3

1. Non-invasive prenatal testing (NIPT)/Non-invasive prenatal screening (NIPS) are screening tests and are not diagnostic
2. Positive predictive vale (PPV) is the chance that the positive screen is correct and the pregnancy is affected
3. Screening test should only ever be following by diagnostic testing. Second screening should not be performed
4. Chorionic villus sampling for 10-13 week gestational age
5. Amniocentesis for 16-20 week gestational age