[MOL] Cracking the cancer code.. [01254] Medicine On Line


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[MOL] Cracking the cancer code..



Cracking the Cancer Code:
An interview with Dr. Kenneth Offit, Chief of the Clinical
Genetics Service

For years, science has understood that certain cancers can
be inherited, winding their way through a family like an
ominous thread. Now, thanks to recent breakthroughs in human
genetics, doctors like Kenneth Offit, chief of Memorial
Sloan-Kettering Cancer Center's Clinical Genetics Service,
are using this information to help high-risk individuals
detect cancers early, before they appear, and in some cases
to prevent them altogether.

"As we learned of the genetic basis of cancer through the
late 1980s," Dr. Offit remembers, "Suddenly cancer moved from
this sort of black box -- where you gave cancer-causing
substances to animals and cancers appeared as a result of
what we thought were environmental agents -- to a fundamental
understanding of what those agents did at the level of the
genome."

Not all cancers are hereditary, but genetic defects are at
work even in non-inherited cancers.  A mutation causing
uncontrolled cell growth can occur at any point in one's
lifetime, either spontaneously, when a mistake is made during
cell division, or as a result of exposure to a toxic
substance.

As a result of the new discoveries and the new information
they provided, the Clinical Genetics Service at Memorial
Sloan-Kettering was created, offering genetic counseling,
testing, and education for individuals with high risks of
hereditary cancers. 

The service has gone from seeing a few dozen cases in 1993
to today's caseload of well over a thousand cases a year. The
counseling and genetic testing services provided by MSKCC's
Clinical Genetics Service are typically recommended for
individuals with family histories marked by multiple cases of
cancer or cancer diagnosed at unusually young ages.

Prevention genetics entails testing people before they have
any sign of the disease, then, if necessary, taking
appropriate measures, such as changes in diet, lifestyle and
screening schedules, or preventive surgery.  Diagnostic
genetics can indicate the earliest stages of certain common
cancers, when doctors can most effectively intervene. And
predictive genetics can provide valuable information about
the course a cancer will probably take, information that in
turn can help to guide potential therapies.

"It's important to note that information about heredity and
family history may or may not include genetic testing," Dr.
Offit clarifies. "You can come in and get a lot of
information without a genetic test. And in many cases a
genetic test is something we wouldn't necessarily
recommend."

In the end, the service enables individuals to understand
their risk, and armed with this understanding, make informed
decisions. Naturally, questions and concerns about the
potential benefits and dangers of this powerful new resource
will be raised.  Common concerns, including fear of
employment or insurance discrimination, are discussed in the
counseling session and an individual's confidentiality is
always protected. 

"Ultimately," Offit concludes, "we talk about what can be
done medically and surgically to prevent or detect cancers at
their earliest, most curable stages.  And the part that is
most exciting is that we can actually intervene in these
families and hopefully we can change the natural history --
which is our way of saying save lives."

For more information about genetic counseling and testing,
contact Memorial Sloan-Kettering Cancer Center's Clinical
Genetics Service at 212-434-5149, or visit our Web site:
http://www.mskcc.org/patients_n_public/lately_oct_2000/cgs.cfm


 
 
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