Prevention

Clinical genetics and genetic counseling

The Clinical Genetics and Genetic Counseling Service at Seattle Cancer Care Alliance (SCCA) offers cancer risk assessment for people who are at high risk of developing cancer because of their personal history and/or their family medical history.

Our cancer geneticists and genetic counselors are here to help you understand the genetic testing process and whether it is an option for you. If so, we’ll explain how knowing the results can affect you medically and emotionally and how to adapt. We’ll also discuss the impact of sharing your results with your family.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Geneticist A scientist who has special training in the study of genes and heredity (the passing of genetic information from parents to their children). A scientist who has special training in the study of genes and heredity (the passing of genetic information from parents to their children). A medical geneticist is a doctor who specializes in diagnosing and treating genetic disorders or conditions. Medical geneticists also counsel individuals and families at risk for certain genetic disorders or cancers. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
“Some of our patients have family who were diagnosed with young-onset cancer. They’ve wondered if there’s a hereditary reason. When testing confirms this is true, it empowers them, allowing their care team to develop prevention and early detection plans for them.”
— Mercy Laurino, MS, CGC, PhD

Frequently Asked Questions (FAQs)

What is genetic testing?

Genetic testing involves analyzing a sample of your DNA for specific genetic changes. The DNA sample can be taken from blood, saliva or sometimes from a skin biopsy. The decision to have genetic testing is a personal, informed choice.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
Why should I consider genetic testing?

If you have cancer, testing can provide your oncologist with new information that can lead to more precise treatment. If you don’t have cancer, the results can help us build your prevention plan. Testing results can benefit your blood relatives, too, by helping them better understand their own risk.

Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.
What is genetic counseling?

Genetic counseling is the process of providing education and emotional support to patients about inherited conditions and how they impact you and your family. The goal of genetic counseling is to provide clear and useful information about genetic risk factors in a way that helps you make the right decisions for you about cancer treatment, prevention or early detection.

Do I need a referral to the SCCA Clinical Genetics and Genetic Counseling Service?

To have a consultation with our genetic specialists, you can either be referred by your physician or you can contact us directly. Appointments are available to current SCCA patients as well as people who are considered high-risk (for example, people who have a family medical history of cancer).

Why do I need genetic counseling? Can’t I just get tested?

During your genetic counseling visit, we will give you information that will help you decide if genetic testing is right for you. We’ll discuss any concerns you may have about genetic testing as well as the possible results, benefits, risks and limitations of testing. We will also talk about cost, insurance coverage and other important issues related to your care.

Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
Who should consider genetic testing?

Many people consider genetic testing if they have one or more family members who have had cancer. You may want to see our cancer geneticist or a genetic counselor to discuss testing, or your physician may refer you, if you have had any of the following:

  • Young-onset breast cancer (diagnosed before age 50)
  • Triple-negative breast cancer
  • Ovarian cancer
  • Young-onset uterine cancer (diagnosed before age 50)
  • Young-onset colorectal cancer (diagnosed before age 50)
  • Multiple colon polyps or young onset of polyps (before age 40)
  • Pancreatic cancer
  • Two or more separate cancers diagnosed at the same or different times
  • Breast cancer and/or prostate cancer, and you are a man
Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Polyp A growth that protrudes from a mucous membrane.
How can knowing my results help my family?

If testing shows you have a gene mutation linked to inherited cancer risk, your blood relatives might be at higher risk, too. If it’s appropriate, and if they are interested, we can provide genetic counseling and testing for your family members. We can also guide them to resources for screening and early cancer prevention.

Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.
SCCA Clinical Genetics and Genetic Counseling Service
fax (206) 606-6135

What to expect during your first visit

Before you have genetic testing, you will have a genetic counseling visit. During this visit, you will talk with a cancer geneticist or a licensed, board-certified genetic counselor. Our genetic counselors are specially trained in genetics, counseling and risk assessment, and they will explain the pros and cons of knowing your genetic testing results. Our genetic specialists will review your family medical history and will help you prepare to understand what your test results mean.

If you decide to have genetic testing after you meet with a cancer geneticist or a genetic counselor, we will take a sample of your DNA either through a blood draw, by swabbing the inside of your mouth for a saliva sample, or sometimes through a skin biopsy. Next, we send it to a genetic testing laboratory. After your results come in, we will meet again, over the phone, via telehealth or in person, to discuss what your results mean for your health and your family. 

Testing the right gene

For genetic testing to be helpful, it’s important to test for the correct gene. There are many genes that may make you more likely to develop certain cancers, such as breast, ovarian, colon or uterine cancer. The most commonly tested genes are the BRCA1 and BRCA2 genes. Disease-causing mutations (changes) in these genes have been linked to hereditary breast and ovarian cancer syndrome.

Other cancer syndromes that may also lead to early-onset cancer in a family include Lynch syndrome (HNPCC), familial adenomatous polyposis (FAP), Cowden syndrome (CS) and Li-Fraumeni syndrome (LFS). 
At SCCA, all of our genetic counselors are licensed and board-certified and specialize in cancer genetics. Because they focus on cancer genetics, their deep knowledge allows them to offer the best care to our patients. 
 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited. Lynch syndrome An inherited disorder in which affected individuals have a higher-than-normal chance of developing colorectal cancer and certain other types of cancer, often before the age of 50. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant.
Multigene panel testing

Genetic testing is an exciting and rapidly growing area of medicine, and research continues to give us new insights. For decades, physicians and genetic researchers looked for gene mutations that might cause cancer one at a time, since it was all they knew about. Testing was also limited because it was slow and expensive. Because of these limitations, some patients who could have been helped by knowing their risk of cancer didn’t get tested. 

But in 2013, advanced multigene technology was introduced, allowing physicians and researchers to examine dozens of cancer genes at the same time. 

It’s important to know that although testing can provide many insights into your possible risk of cancer, the results can also be hard to interpret. Sometimes there is no clear course of action for you to take, because researchers still don’t have enough information to guide people in prevention strategies for several of the genes tested.

This is why it’s essential to work with a skilled genetics counselor who can select the right test for you, help interpret your results and explain all your options so you can make an informed choice.
 

Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant.
Other tests

Many genetic tests are available, including tests that anyone can buy at a local drugstore or online. Those tests are very different from the ones we use. Our tests have been developed in academic laboratories like those from SCCA’s partner organization, the University of Washington Medical Center (UW Medicine). The UW lab has developed, and continues to improve, unique genetic tests for use in understanding inherited cancers. One example is a test for certain blood cancer genes, called the MarrowSeq™ Hereditary Bone Marrow Failure Panel. Our experts will help decide which genetic tests are right for you, interpret your test results and help you move forward.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited.

Inherited cases of cancer

Cancer develops when abnormal cells divide and grow without being stopped. Hereditary cancer occurs when a person inherits an altered gene, or gene mutation, from a parent. In some cases, they can be the first person in the family to have the genetic change (de novo). 

Learn More About Inherited Cancers
 

What happens after testing

If you decide to have genetic testing, your results will help us give you prevention and early detection management recommendations. SCCA prevention specialists will recommend high-risk cancer prevention and surveillance (monitoring) options for you. 

For example, if a woman tests positive for a disease-causing mutation in the BRCA1 or BRCA2 gene, we may recommend that she get regular cancer screenings to detect cancer early through SCCA’s Breast and Ovarian Cancer Prevention Clinic. After that, she might move to our Women’s Wellness or High-Risk Surveillance Clinic. At these clinics, we might offer her options like preventive surgery or lifestyle changes to reduce her risk of cancer.

Our cancer geneticist or genetic counselor will help you understand what you may be facing once you receive your test results.

Care team

Learn about what each team member does.

Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited. High-risk cancer Cancer that is likely to recur (come back) or spread. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.
Cancer geneticist

Our cancer geneticist is one of the few medical doctors in the U.S. who has trained in preventive medicine, medical oncology and medical genetics. She has experience in using genetic tools to help understand how certain targeted therapies can help patients at high risk of cancer. She considers cancer and risk of cancers from many different angles, and she designs plans for screening, surveillance (monitoring), early detection and prevention for patients who have a higher genetic risk of cancer.

Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Genetic counselor

This specially trained health care provider helps you understand your risk of a genetic disorder. A genetic counselor can also determine if genetic testing could be helpful for you, based on your personal and family medical and health history. After you have had genetic testing, a genetic counselor can offer information and resources for prevention; connect you with prevention programs, such as those available at SCCA; and help with testing your family members, based on your results. SCCA Genetic Counseling Service providers are all licensed, board-certified genetic counselors.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.
Patient care coordinator

Your patient care coordinator will likely be one of the first people you meet when you come to SCCA. They will gather your medical records and family health history and help guide you to the appropriate genetics or prevention care services within SCCA.

Find care team profiles

Meet the caring, dedicated people who take care of you and your family at SCCA.

Marianne  Dubard-Gault, MD, MS
Marianne Dubard-Gault, MD, MS
Physician
Genetics
Marshall S. Horwitz, MD, PhD
Marshall S. Horwitz, MD, PhD
Physician
Genetics

Genetic counselors

SCCA Genetic Counseling Service providers are all licensed, board-certified genetic counselors.

Lauren Brown, MS, CGC
Lauren Brown, MS, CGC

Lauren Brown provides counseling for a variety of hereditary cancer syndromes. She enjoys coming alongside patients to share meaningful and relevant genetic health information. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. In her free time, Lauren enjoys biking and overlanding (a fusion of camping and off-roading).

Lauren Facchini, MS, CGC
Lauren Facchini, MS, CGC

Lauren Facchini provides counseling for a variety of hereditary cancer syndromes. She has a special interest in genitourinary malignancies and focuses on helping patients understand how genetic test results can impact their personal and family’s risk for disease. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. 

Cynthia Handford, MSc, CGC, CCGC
Cynthia Handford, MSc, CGC, CCGC

Cynthia Handford has been a genetic counselor since 2007 and has worked in both clinical and laboratory settings. She has a special interest in hereditary cancer and enjoys helping patients and their families use genetic information to be proactive with their health. Cynthia is certified by the American Board of Genetic Counseling as well as the Canadian Association of Genetic Counselors and licensed by the Washington State Department of Health.

Everett Lally, MS, CGC
Everett Lally, MS, CGC

Everett Lally provides counseling for a variety of hereditary cancer syndromes. He has a special interest in cancer genetics with a focus on gastrointestinal diseases and prostate cancer. He is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. 

Mercy Laurino, MS, CGC, PhD
Mercy Laurino, MS, CGC, PhD

Mercy Laurino is the Director of SCCA’s Genetics and Prevention programs. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. She is the 2016 recipient of the International Leader award from the National Society of Genetic Counselors and Past-President of the Professional Society of Genetic Counselors in Asia. She co-chairs the UW Genetic Counseling Graduate Program’s Diversity, Anti-Racism, and Equity (DARE) committee and currently serving as Board Secretary for the Asia Pacific Society of Human Genetics.

Lorraine Naylor, MS, CGC
Lorraine Naylor, MS, CGC

Lorraine Naylor provides counseling to patients referred for a variety of inherited conditions. She has a special interest in cancer genetics, with a focus on gastrointestinal malignancies. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.

Britta Sjoding, MS, CGC
Britta Sjoding, MS, CGC

Britta Sjoding is a certified genetic counselor and primarily provides cancer genetic counseling service to our SCCA community sites. Counseling patients regarding hereditary cancer syndromes since 2009, she is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.