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Hereditary Cancer Panels: MYvantageTM Hereditary Comprehensive Cancer Panel and GIvantageTM Hereditary Colorectal Cancer Panel

Test code(s) 93768, 93791

Question 1. What are the benefits of multi-gene panels?

Multi-gene panels simultaneously analyze a group of hereditary cancer-predisposition genes. They are most useful for patients with a personal or family history of cancer that does not clearly point to a specific cancer syndrome. Such panels can also identify patients with hereditary cancer predisposition when the clinical suspicion remains high despite a negative result on a single-gene/syndrome genetic test. Use of a multi-gene panel can be an efficient approach to genetic testing.

Question 2. What is the cancer risk associated with a positive result (pathogenic or likely pathogenic mutation detected)?

The risk of cancer depends on which pathogenic/likely pathogenic variant is detected in a given gene. Each gene is placed into a risk category based on 2 criteria: 1) the highest relative-risk for cancer conferred by the variant(s) in that gene, and 2) whether the variant(s) in the gene is a cause of a recognized genetic syndrome. Categories are defined as follows:

Question 3. What is included in the 2 panels?

93768 MYvantageTM Hereditary Comprehensive Cancer Panel
This panel analyzes 34 genes. Point mutations, deletions, and duplications are detected in APC,ATM, BARD1, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CDKN2A (p14ARF and p16), CHEK2, MEN1, MLH1, MSH2, MSH6, MUTYH, NBN, NF1, PALB2, PMS2, POLD1, POLE, PTEN, RAD51C, RAD51D, RET, SDHB, SDHC, SDHD, SMAD4, STK11, TP53, and VHL. Deletion testing is performed for 3ʹ-EPCAM. This includes genes in the high-risk, moderate-risk, and emerging-risk categories.

93791 GIvantageTM Hereditary Colorectal Cancer Panel
This panel analyzes 13 genes. Point mutations, deletions, and duplications are detected in APC, BMPR1A, CDH1, LH1, MSH2, MSH6, MUTYH, PMS2, PTEN, SMAD4, STK11 and TP53. Deletion testing is performed for 3ʹ-EPCAM. This includes genes in the high-risk category.

Question 4. Who may be appropriate for these tests?

The following individuals may be appropriate for these tests:

  • Individuals with a personal history of cancer who have tested negative for a single gene or syndrome, but whose personal or family history remains strongly suggestive of an inherited susceptibility
  • Individuals with several different types of cancer in the family history that do not seem to fit a particular hereditary cancer syndrome

Informed consent following genetic counseling is strongly recommended.

Question 5. What guidance can you give for choosing between the 2 panels?

There is a fair amount of overlap in the genes included in these panels. The larger MYvantage panel includes all of the genes found in the GIvantage panel. The following information may help you select between the two:

  • The MYvantage panel includes 34 genes associated with a broad spectrum of hereditary cancers. This can include, but is not limited to, cancers of the breast, colon, endometrium, ovary, pancreas, prostate, rectum, neuroendocrine system, and other tissues. Most genes have National Comprehensive Cancer Network (NCCN) management recommendations for one or more cancer site.
  • The GIvantage panel includes 13 genes predominantly associated with gastrointestinal cancers. This can include, but is not limited to, cancers of the colon, pancreas, rectum, stomach, endometrium, and other tissues. All genes have NCCN-management recommendations for one or more cancer site.

Question 6. The gene mutation in my patient’s family is known. Is there a better test for my patient?

Yes. Please call Quest Genomics Client Services at 866.GENE.INFO to discuss this case with a genetic counselor and get help with selecting the most appropriate test.

Question 7. Whom can I ask for help if I don’t know which test to order?

You can ask one of our genetic counselors. Please call Quest Genomics Client Services at 866.GENE.INFO to talk with a genetic counselor.

Question 8. When is the right time to test my patient?

The right time is different for every patient. A patient’s current medical status, personal experience with cancer, and general readiness for genetic information all influence the decision to be tested. Having an open dialogue with your patient about these topics can assist with shared decision-making.

Question 9. My patient has a positive result. What does this mean?

Patients with a positive result (pathogenic or likely pathogenic mutation detected) have an increased risk for developing certain cancers relative to the general population. The National Comprehensive Cancer Network (NCCN) provides up-to-date surveillance and management recommendations that can often be used, depending on the gene in question (www.nccn.org). Consider referring the patient to an oncology center experienced in treating patients with a hereditary predisposition to cancer. Such a center can discuss available options with the patient. These options may include increased surveillance, chemoprevention, and prophylactic surgery. Genetic counseling for family members is advised.

Question 10. My patient has a negative result. What does this mean?

A negative result means that pathogenic or likely pathogenic mutations were not found in the genes included in the panel. Implications of this result depend on the situation:

  1. Patient previously diagnosed with cancer: Your patient’s risk of recurrence or a related new cancer is based on his/her personal and family histories of cancer. In some instances, it may be appropriate to test for other hereditary forms of cancer. Please call Quest Genomics Client Services at 866.GENE.INFO to discuss possible additional studies with a genetic counselor.
  2. Patient not previously diagnosed with cancer, but with a family history of cancer: Testing an affected family member is recommended for proper risk assessment. Your patient’s risk of cancer is based on his/her personal and family histories of cancer. In some instances, it may be appropriate to test for other hereditary forms of cancer. Please call Quest Genomics Client Services at 866.GENE.INFO to discuss possible additional studies with a genetic counselor.

Question 11. My patient has a variant of unknown clinical significance (VUS). What does this mean?

A VUS result means that the variant has not been previously described in the literature or the clinical significance is unclear based upon currently available evidence. Medical-management decisions should be based on personal and family history. Family studies may be indicated to better understand the clinical significance of this variant. If you have questions, please call Quest Genomics Client Services at 866.GENE.INFO to speak with a genetic counselor.

Question 12. Where can I find more information on the MYvantagepanel and the GIvantage panel?

For additional information regarding our hereditary cancer test offerings, please visit QuestVantage.com.

 

References

  1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Genetic/familial high-risk assessment: colorectal. V2.2016. Rockledge, PA: National Comprehensive Cancer Network, 2016. Available at www.NCCN.org.
  2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Genetic/familial high-risk assessment: breast and ovarian. V2.2017. Rockledge, PA: National Comprehensive Cancer Network, 2017. Available at www.NCCN.org.
This FAQ is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.
Document FAQS.185 Version: 1
Version 1 effective 04/28/2017 to present
Version 0 effective 06/03/2016 to 04/28/2017