Hereditary Cancer Risk Testing: What to Expect PHONE APPOINTMENT The first appointment with the Vanderbilt Hereditary Cancer Clinic is by phone. We will record your family history information and create a pedigree (family tree diagram). Before your phone appointment, we will send you a family history form (included at the end of this packet) and information about the clinic. At the end of the phone appointment, we ll schedule a face-to-face appointment with one of our genetics providers. To help create a more accurate cancer risk evaluation, we will ask patients to collect family history information before their phone appointment. Important information includes: Who in the family has been diagnosed with cancer? Where their cancer(s) started, what type, and if the cancer was present on both sides (for example, in both breasts) or in more than one place How old they were when diagnosed with cancer If anyone in the family has undergone genetic testing, the results of that test If you would like to fill out our questionnaire in advance, use the form included at the end of this packet. Documentation of cancer is an important part of the cancer risk assessment. In some cases, its helpful if you can find pathology records for family members who have had cancer or suspected cancer. Other medical records, death certificates, pathology specimens, etc. can also be helpful. Your provider can provide guidance about what records might be helpful depending on the family history. FACE-TO-FACE APPOINTMENT After your phone appointment, you ll be scheduled for a face-to-face appointment at one of our clinic locations. The face-to-face appointment can include: Review of family tree created during the phone appointment and creation of a cancer risk assessment based the family tree Education on cancer, cancer genetics, risk and related topics Discussion of whether a gene linked to risk for cancer may be passed down in the family When appropriate, discussion of testing options and insurance coverage for genetic testing A plan for learning testing results is made; usually patients will return to learn their results in person If appropriate, referrals for participation in research relating to a patients specific condition
Discussion of options for cancer screening and risk reduction. When appropriate, appointments can be arranged with medical specialists.
Vanderbilt Hereditary Cancer Clinic FAMILY HISTORY QUESTIONNAIRE The information in this questionnaire will be used to draw your family history diagram (also known as a pedigree) For unknown information, use approximates Examples: Diagnosed: mid-50 s 10-20 colon polyps When known, record specific cancer types and/or pathology General: Kidney cancer Specific: Clear cell renal cell carcinoma Please include all family members asked about in this questionnaire, no matter if they have had cancer or not, or if they are living or deceased. o If you have many cousins, list only those who have had cancer If there is not enough space, use the back of the page, or add additional sheets. Example: Father John 65 Father s If you have questions about this form, please contact the Hereditary Cancer Clinic at: Phone: (615) 322-2064 Fax: (615) 343-3343 Mail: Hereditary Cancer Clinic Village at Vanderbilt, Suite 2500, 1500 21 st Ave South Nashville, TN 37212 colon polyps: 7 adenomatous 3 hyperplastic Please have this form for reference during your telephone appointment. Jane 49 Bilateral breast cancer, triple negative 45, 49 55
YOURSELF : Date of Birth: Cancers, tumors or growths: : Your Children Your Brothers and Sisters Please note half siblings Full or Half Page 2
Your Father s Relatives Ancestry/Ethnic background (German, African American, Jewish, etc.) Father Cause of death, if deceased Father s Father Father s Your Paternal Aunts and Uncles (Father s Brothers and Sisters) Your Paternal Cousins (list only cousins who have had cancer) Their parent s name Page 3
Your s Relatives Ancestry/Ethnic background (German, African American, Jewish, etc.) Cause of death, if deceased s Father s Your Maternal Aunts and Uncles ( s Brothers and Sisters) Your Maternal Cousins (list only cousins who have had cancer) Their parent s name Page 4
Relatives in Your Extended Family with Cancer, Tumors or Growths Not listed on this Form (for example, great aunts or uncles) List any other relatives you know of that have had a cancer, tumor, or growth Example Relationship to you (mother s or father s side?) Father s mother s sister (great aunt) or Death Cancer(s) 80 Melanoma 65 Page 5