Prevention

High risk cancer surveillance

Although finding out you are at high risk for a cancer is not welcome news, it is an important first step that can ultimately be empowering. Knowing your risk means you can manage it more actively — and if a disease does begin to develop, it can often be caught in a precancerous or early stage, when it is most treatable.

At the High Risk Surveillance Clinic at Fred Hutchinson Cancer Center, we offer a personalized approach to managing your cancer risk, which combines monitoring, lifestyle changes and education to help reduce your risk while supporting your overall physical and emotional health.

Precancerous A condition that may (or is likely to) become cancer. Also called premalignant. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. 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.

“Patients have shared that they feel a sense of control and reassurance when they come here. Our one-patient/one-plan approach for screening, surveillance, early detection and prevention makes a difference in moving the needle to catch lesions before they become cancerous.”

— Marianne Dubard-Gault, MD, MS, Cancer Geneticist

High Risk Surveillance Clinic

We work with people who are already Fred Hutch patients as well as those who are new to Fred Hutch, managing their risk and working closely with their primary care physician and other health care providers. And, when appropriate, we can draw on our entire network of Fred Hutch medical experts — from urologists and gastroenterologists to blood cancer experts, pulmonary specialists and more — to gain further insights or get you the care you may need.

If you have already visited an Fred Hutch prevention or genetics program

If the results of your genetic testing or risk assessment at one of Fred Hutch’s prevention programs show that you may be at a higher risk of developing a hereditary cancer — for example, if a certain type of cancer runs in your family — that program may refer you to us. We’ll call you to schedule your appointment.

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.

If you have not been to Fred Hutch

If you have not been to Fred Hutch, but you already know you may be at higher risk for hereditary cancers — for example, if a certain type of cancer runs in your family — you can be referred to the program by your primary care provider, or you can contact the program.

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.

Fred Hutch High Risk Surveillance Clinic

phone (206) 606-6100

fax (206) 606-6135

What happens at your visit

Like other patients who come to our clinic, you have a higher risk of cancer. However, there are many factors that make you entirely unique: the type of disease you are preventing or managing, your overall health, your age, your specific genetic risk and more. We consider all of these factors when managing your risk.

At your first appointment, our cancer geneticist will meet with you to discuss your unique situation and surveillance plan, going over any imaging or tests that have already been done and how we will work together to implement the plan. If you do not yet have a prevention plan, we will work with you to develop one. We may also discuss referrals to other specialists as needed.

Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. 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.

Follow-up care

The follow-up care you have will vary: You may go to a Fred Hutch location for a screening, such as a colonoscopy. Or your primary care physician may arrange a test for you, such as a blood test. You might need some tests more often, perhaps every other month. For other tests, you may only need screening once or twice a year.

As time passes, we will continue to review your plan, and we may decide to change it. If so, we’ll discuss the changes, and why we are making them, with you.

Colonoscopy An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. 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.

Screening and surveillance

Many screening strategies are available, and the screening and surveillance used for you will depend on your unique circumstances and type of disease. Imaging is one of the most common types of screening, but other organ-specific screenings may also be used. For example, if you are at high risk for colon cancer, regular colonoscopies can be used to detect precancerous polyps and remove them. Or, if you are at high risk for prostate cancer, active surveillance will likely include a combination of regular blood tests to measure a protein made by the prostate, called PSA, as well as regular digital rectal exams (DREs). We will help ensure you get the screenings you need on a schedule that is best for you.

Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Precancerous A condition that may (or is likely to) become cancer. Also called premalignant. 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. Watchful waiting Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. During watchful waiting, patients may be given certain tests and exams. Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management. Prostate-specific antigen A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have certain prostate diseases or conditions.

A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate gland.

Preventive therapy

Preventive therapy may be a prevention strategy that’s right for you. Preventive therapy is when a physician prescribes vaccines, medications or natural therapies to help block cancer cells from growing. Sometimes it can be used to stop or even reverse the growth of precancerous cells where damage has already occurred. Preventive therapy benefits a variety of people: healthy people at high risk of developing certain cancers; people with precancerous conditions; and people who have already been treated for cancer, to help keep it from coming back.

Precancerous A condition that may (or is likely to) become cancer. Also called premalignant.

Risk reduction surgery

Risk reduction surgery is sometimes recommended in healthy people who have a high risk of developing cancer. It may also be used to remove tissues that do not contain cancerous cells but could become cancerous. For instance, polyps (clumps of cells) in the colon could be removed if they are considered precancerous. Risk reduction surgery might also be performed if you have already been treated for or diagnosed with a type of cancer.

Precancerous A condition that may (or is likely to) become cancer. Also called premalignant.

Lifestyle habits to reduce risk

Regardless of the type of cancer you may be at risk for, you can adopt lifestyle habits that will support your overall health and help reduce risk. These range from stopping smoking and losing weight to making specific changes to your diet.

Our team will identify lifestyle habits you can improve, and we can get you the support and resources you need to change them in your daily life.

Care team

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, 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.

Advanced practice provider (APP)

These health care professionals work closely with your physician in the clinic. There are two types: physician assistants (PAs) and advanced registered nurse practitioners (ARNPs). They help provide and coordinate your care and can see you independently from your physician.

Nurse practitioner A registered nurse who has additional education and training in how to diagnose and treat disease. In cancer care, a nurse practitioner may manage the primary care of patients and their families. A registered nurse who has additional education and training in how to diagnose and treat disease. Nurse practitioners are licensed at the state level and certified by national nursing organizations. In cancer care, a nurse practitioner may manage the primary care of patients and their families, based on a practice agreement with a physician. Physician assistant A health professional who is licensed to do certain medical procedures under the guidance of a physician. A health professional who is licensed to do certain medical procedures under the guidance of a physician. A physician assistant may take medical histories, do physical exams, take blood and urine samples, care for wounds and give injections and immunizations.

Registered nurse (RN)

Your nurse manages your care alongside your physician. They also assist with procedures and treatments. Nurses are resources for you and your caregiver. They can answer questions and help with a wide range of topics, like how to cope with side effects or how to get other services you need at Fred Hutch.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Patient care coordinator

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

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