It would be hard to identify the medical

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1 You no longer have to be sick to get tested for serious diseases like cancer or diabetes. In fact, if you or your family discovers you re likely to get these conditions, there may be preventative measures that could potentially save your life. Brought to you by 1

2 Genetic Testing: The New Frontier for Medical Care 2/6 It would be hard to identify the medical breakthrough that has had the greatest impact on improving lives. It could be in vitro fertilization, bionic limbs, HIV treatment or laparoscopic surgery. But a case can be made that screening for cancer and other diseases before they happen, through genetic testing, might impact more lives in the 21st century than any other advance. That s because you don t have to be sick to get a genetic test that might identify a host of genetic predispositions. In fact, if you or your family discover there s a high probability that you may get these diseases, you could conceivably increase the chance of avoiding these diseases if you start taking preventative measures to combat them. Deeper Genetic Testing In past years, if you had cancer or another disease, targeted genetic testing could identify whether other members of your family could have a high risk of the same ailment. This may be funded by provincial health care systems. 1 However, a newer trend, which some healthcare clinics, such as Medcan, a preventative health and wellness provider, offer to their patients, is broader and deeper genetic testing to discover any future risks for disease and conditions. For example, if someone has colon cancer in their family but there is not enough colon Allison Hazell Clinical Director, Genetic Program, Medcan Allison Janson Hazell is a Canadian and U.S. board-certified Genetic Counsellor based in Toronto and is Past President of the Canadian Association of Genetic Counsellors. Allie joined Medcan in 2010 and prior to this held a position in the Adult Genetics Clinic at University Health Network/Mount Sinai Hospital. Allie earned her Master s in Human Genetics from Sarah Lawrence College in New York, and holds a certificate in Public Health Genetics and Genomics. She was among the first genetic counsellors to champion social media within the profession, having co-founded The DNA Exchange where she remains a principal contributor.

3 Genetic Testing: The New Frontier for Medical Care 3/6 cancer in the family to qualify for provincially covered genetic testing, they may opt to pay privately for genetic testing for a panel of genes related specifically to colon cancer, or a comprehensive test looking at genetic risks for many different types of cancer, says Allison Hazell, a Clinical Director of the genetic program at Medcan. Genetic Testing A Significant Signpost In her role, Hazell interprets the family history of clients/patients in conjunction with genetic tests to help people make educated health decisions. She says the testing allows people to be proactive if they feel the need to head off disease. Genetic testing certainly can t predict all cancers and diseases but may offer a The goal is to use significant signpost for a handful of prominent cancers (ovarian, breast, genetic testing prostate, lung and melanoma), and to identify high other diseases and conditions from risk individuals cholesterol problems to obesity. while they are still Moreover, it may empower people healthy, so we can to make choices today that could ideally intervene impact their health tomorrow. From before they even profound decisions like having get sick. mastectomy to less invasive choices ALLISON HAZELL, like what you eat; the full spectrum CLINICAL DIRECTOR, GENETIC PROGRAM, MEDCAN. of choices that can help plot a course for a healthier life. The goal is to use genetic testing to identify high risk individuals while they are still healthy, so we can ideally intervene before they even get sick, says Hazell. Depending on a patient s circumstance, they can undergo a range of genetics tests. For example, there is a test specifically for hereditary cancers, or a personal genome test which checks for common health conditions

4 Genetic Testing: The New Frontier for Medical Care 4/6 that have both a genetic and environmental aspect to them such as heart disease, diabetes or Alzheimer s. The screenings cost between $1,000 and $1,500 at Medcan. 2 Medcan Genetic Testing Each test or evaluation includes consultation and a plan for identifying health risks. Personal Genome Testing Determine your genetic predisposition to more than 25 common health conditions. Work with a Genetic Counsellor to develop a personalized plan for screening tests and lifestyle changes designed to decrease your genetic risk for disease. Hereditary Cancer Panel Testing If there is a strong history of cancer in your family a targeted genetic test can evaluate multiple cancer genes at once. Genetic Family Risk Assessment A review of risks for genetic disease and risk assessment faced by you and your family members for rare and common diseases. Pharmacogenomics Reduce trial-and-error prescribing by predicting which medications and dosages may be most effective for you and are least likely to cause adverse side-effects. Based on the pharmacogenomics genetic test, determine response and effectiveness to a panel of 200+ medications. Nutrition and Fitness Genomic Testing Fine-tune your nutrition and fitness regime, and optimize results, when testing over 75 genetic markers related to metabolism, diet, nutrition and exercise. Making Long-term Lifestyle Changes Knowing that you may have a genetic propensity to obesity means that people can make long-term lifestyle changes, with the help of a doctor and a dietician, to compensate for what their genes have dealt them. Moreover, genetic testing for medication sensitivities can give doctors information on what drugs are likely to work. This could save time, money and possibly lives if a treatment involves a trial and error system of finding out which drugs are required.

5 Genetic Testing: The New Frontier for Medical Care 5/6 For a patient, the genetic screening procedure is straightforward. A phlebotomist, a technician who is trained to draw blood, takes a sample in the same way any other sample is taken in the arm, although genetic samples can also be obtained through a cheek swab. The sample is sent to a lab where it is examined for genes associated with particular groups of health conditions and involves identifying the presence of mutations in these genes. The results are relayed back to a genetic counsellor who reviews the results and consults with the patient. I always tell people that they should be going into the testing scenario with their eyes wide open. Hazell says people seeing blood relatives fight cancer can consider genetic testing that may shed light on whether they have a propensity for the same cancer. But she says some people are ALLISON HAZELL, naturally gun-shy about hearing CLINICAL DIRECTOR, what could be bad news, which GENETIC PROGRAM, MEDCAN. is completely normal. Thus, there is a need for genetic counsellors to work with the individual or family, not only to interpret medical information, but also family genetic inheritance patterns and risks of occurrence for the disease or disorder. Genetic counsellors are trained to communicate the scientific information in understandable terms, while we also attend to the emotional aspects of making a decision about whether or not to pursue a genetic test, Hazell says. Hazell says it is critical for people who wish to have tests done to seek out counselling before they pursue the test. Receiving news that indicates you are at high risk for cancer can be difficult. I always tell people that they should be going into the testing scenario with their eyes wide open; What will it mean for your own medical

6 Genetic Testing: The New Frontier for Medical Care 6/6 management? What are the implications for your children? Considering the potential implications before doing the test means that you are better prepared to handle a positive result, Hazell says. And it s important to note that sometimes genetic testing can be really reassuring. If there is a known genetic mutation in the family and you don t carry it, then we know you are not at increased risk to develop the same condition. Genetic testing has suddenly gone high profile as prominent individuals are more open today about the medical battles they face and the preventative steps they have taken to deal with their diseases. In fact, a study at Sunnybrook Hospital in Toronto revealed a 90% jump in the number of women referred for genetic counselling. 3 This came six months after a leading Hollywood star wrote about her experiences discovering she carried the genetic mutation, BRCA1, which indicates an extremely high risk for breast and ovarian cancer, and having a double mastectomy. We know the risks for cancer, heart disease, and diabetes will increase as we get older. Therefore, the more information you have earlier on, the more time you have to impact the outcome, Hazell says. Don Sutton, MoneyTalk Life 1 Rules and funding differs by province. 2 Tests and prices subject to change. Other health care clinics may provide similar tests. 3 Jacques Raphael, Sunil Verma, Paul Hewitt, Andrea Eisen, The Impact of Angelina Jolie (AJ) s Story on Genetic Referral and Testing at an Academic Cancer Centre in Canada, Journal of Genetic Counseling, DISCLAIMER: The information contained herein has been provided by TD Wealth and is for information purposes only. The information has been drawn from sources believed to be reliable. Where such statements are based in whole or in part on information provided by third parties, they are not guaranteed to be accurate or complete. Graphs and charts are used for illustrative purposes only and do not reflect future values or future performance of any investment. The information does not provide financial, legal, tax, or investment advice. Particular investment, trading, or tax strategies should be evaluated relative to each individual s objectives and risk tolerance. TD Wealth, The Toronto-Dominion Bank and its affiliates and related entities are not liable for any errors or omissions in the information or for any loss or damage suffered. TD Wealth represents the products and services offered by TD Waterhouse Canada Inc. (Member Canadian Investor Protection Fund), TD Waterhouse Private Investment Counsel Inc., TD Wealth Private Banking (offered by The Toronto-Dominion Bank) and TD Wealth Private Trust (offered by The Canada Trust Company). All trademarks are properties of their respective owners. The TD logo and other trade-marks are the property of The Toronto-Dominion Bank. Brought to you by