Genetic Counselling in Action - 2 - Genetic Risk Assessment

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[00:00:07.70] So Helen, nice to see you again.

[00:00:09.55] Yeah, you too.

[00:00:11.06] So since I last saw you, we have been able to get some more information about
the cancers in your family--

[00:00:16.64] Great.

[00:00:16.98] --which has helped us make an assessment for you.

[00:00:19.94] Yeah.

[00:00:21.11] And we can be quite reassuring about your risk. But I'd like to go through the
details with you first, if that's all right?

[00:00:28.05] OK. Yeah.

[00:00:29.54] So your mum signed a consent form. So we've got some more information
about her breast cancer.

[00:00:35.51] Yeah. Yeah.

[00:00:37.28] And we also got some information about your aunt.

[00:00:41.68] OK.

[00:00:42.26] And you're quite right. She did have an operation on one of her breasts in her
60s.

[00:00:47.37] Yeah.

[00:00:48.05] But what she actually had was a condition that isn't a breast cancer. But it's
something called Ductal Carcinoma In Situ, or DCIS, that can sometimes go on and become a
breast cancer--

[00:01:02.45] OK.

[00:01:03.11] --but often doesn't.

[00:01:05.60] OK.

[00:01:06.68] And in the cancer registries, we were able to find that she had a lung cancer.

[00:01:12.17] OK.
[00:01:13.23] And that is what she died of.

[00:01:15.17] So the main cancer was a lung cancer?

[00:01:17.15] Her main cancer was a lung cancer.

[00:01:18.80] Oh, OK. So I didn't know that. OK. She was a heavy smoker, so--

[00:01:23.18] She was.

[00:01:23.45] Yeah.

[00:01:24.12] And that is very linked--

[00:01:26.18] OK.

[00:01:26.87] --to development of Lung cancer.

[00:01:27.57] So this pre-- it's pre-cancer breast thing-- that's not significant then?

[00:01:34.49] It makes it much less significant--

[00:01:37.28] OK.

[00:01:37.88] --in the family history. So it lowers your risk.

[00:01:41.14] OK.

[00:01:42.56] And then we also got some information about your grandmother's
gynaecological cancer.

[00:01:47.51] Her ovarian, yeah. Yeah.

[00:01:49.70] So it was gynaecological.

[00:01:52.01] Yeah.

[00:01:52.49] But we found that it was actually a cervical cancer.

[00:01:56.65] OK. That's the same thing, though, isn't it? It's all the same area.

[00:02:01.16] It's in a similar area. But it's at the beginning of the womb, which is below the
ovaries and not the same tissue.

[00:02:08.92] Oh, OK. So it needs to be in the same-- right. OK.

[00:02:12.65] So it's a different type of cancer and is not connected with the hereditary types
of breast cancer, which is very good news from your risk point of view.

[00:02:24.74] So they're all independent. They're not linked.

[00:02:28.58] They're not linked.

[00:02:29.67] It's not a gene?

[00:02:31.10] It's very unlikely that there'd be a gene in your family. A lot of cancer and it's
several different conditions is not linked to a hereditary cause. So most cancer isn't inherited.

[00:02:48.43] So you're saying to me these cancers in the family are just by accident and that
I'm not at an increased risk of getting cancer?

[00:02:58.59] It's much, much more likely that these cancers are not linked.

[00:03:04.48] So I find that really hard to believe, I must admit.

[00:03:15.20] So I know it will take time to adapt to that change in your risk, but this
information really is very reassuring.

[00:03:24.83] So it's actually good news?

[00:03:26.25] It's good news. It's good news.

[00:03:27.69] OK.

[00:03:28.71] Have you been worried about your breasts at all?

[00:03:32.37] No, not especially, but I just felt it would be-- you know, it's just waiting to get
cancer. So what you're saying is I don't really have an increased risk of cancer, which is-- I'm
still getting palpitations. So I'm still feeling very anxious. But then, of course, I'm still dealing
with my mum and things so--

[00:03:51.98] You mentioned before that you were under quite a lot of stress.

[00:03:55.23] Yeah, stress, I know-- and since I last saw you, I did go and see my GP. And he
was quite interested in my dad. And I don't like talking about my dad. But he wondered
whether there's a connection between my dad having a heart attack and me having
palpitations. And I think that's completely ridiculous, because I'm nothing like my dad.

[00:04:15.48] But he also asked me if I'd had any fainting or anything like that. And I
actually have. So I fainted in the shower a few weeks ago. And that has happened before.
And he was quite concerned about that. I hadn't made any connection between that and
palpitations, but anyway. So he's referred me to cardiology. So yeah, so we'll find out
whether there's something heart-related going on.

[00:04:40.54] So have you got an appointment with cardiology already arranged?

[00:04:43.53] Yes, it's coming up. It's coming up, yeah.

[00:04:44.61] Good. And do you feel that that's a good thing.

[00:04:51.24] Well, I'm very practical. I want to get things sorted, you know? I want to know
what that means really, and if I've got some sorts of symptoms, what those mean.

[00:05:02.13] OK. Good. I'm glad that you've been and done that.

[00:05:06.07] Yeah.

[00:05:18.94] And in terms of you coping with everything that's going on at the moment, do
you feel that you've got enough support?

[00:05:25.80] Well, I've got my mum.

[00:05:27.97] And how is she doing?

[00:05:29.59] She's not doing very well. She's going downhill. She's talking about palliative
care now, thinking about hospice. Yeah, so that's-- she's not very good.

[00:05:42.27] Does she know that you've come to talk about breast cancers?

[00:05:44.04] Yeah, she knows. She knows, yeah. So she'll be really surprised to think that
there's no genetic thing that you can test me for. She'll be really surprised.

[00:05:52.50] Do you think she'll be reassured that we don't think you're at increased risk?

[00:05:56.91] Yeah, she'll be reassured. I'm not quite sure if I believe that yet. But I think
she'll be reassured. I'll be pleased to tell her.

[00:06:03.57] Would it be helpful if I put some of that information down in writing--

[00:06:06.69] Yes, definitely-- thank you.

[00:06:08.13] --so that you've got that for your records? And any questions you have about it,
obviously you can come back to us.

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