Cancer Genetics Clinic

About the Department

Approximately 5-10% of cancer is inherited. Individuals with a genetic predisposition will have a far higher chance of developing cancer within their lifetime and at an earlier age. Genetic testing can help determine whether a family has a hereditary cancer predisposition syndrome. Individuals who have genetically higher risks to develop certain cancers are recommended to follow high-risk cancer surveillance and management. The Genetic Cancer Clinic Program can coordinate genetic testing and high-risk cancer surveillance for individuals and their families with hereditary cancer syndromes. 

For further information please view our Referral Guidelines:

Genetic Testing

If you think you might be at risk for an inherited cancer, it's a good idea to meet with a genetics counselor. He or she will review your family medical history, talk to you about the role of genetics in cancer and perform a hereditary cancer risk assessment. This assessment will cover:

  • Your chances of having a genetic mutation
  • Personalized genetic testing recommendations
  • A general estimate of your personal cancer risks
  • Individualized cancer screening and prevention recommendations

How is Genetic Testing Done? 

Based on your cancer risk assessment, the genetic counselor may recommend that you undergo genetic testing. This simply involves having a blood sample drawn. The results may help determine whether members of your family face higher risks for certain types of cancer.

Keep in mind that genetic testing isn't for everyone. It involves many ethical, legal and social issues that require careful consideration. By having a genetic counselor evaluate your family history, you can make a more informed decision about whether genetic testing may be appropriate for you or your family.

Should I consider having cancer genetic counseling?

You should consider seeing a genetic counselor for a cancer risk assessment if your personal and/or family history has features of hereditary cancer. Hereditary cancers tend to differ from non-hereditary cancers in the following ways: 

  • The age cancer is diagnosed is usually younger than in the general population (often younger than age 50).
  • Multiple people from the same side of the family tend to have the same or related types of cancer.
  • Cancer is more likely to develop in more than one site in the body. 

Additionally, people with the following should consider genetic counseling:

  • Breast or ovarian cancer diagnosis with Ashkenazi Jewish ancestry (Eastern or Central European Jews)
  • Polyposis (multiple polyps in the colon, stomach, or small intestine)
  • Certain rare cancers, such as male breast cancer, retinoblastoma, medullary thyroid cancer, or pheochromocytoma/paraganglioma
  • A family member with a genetic test diagnosing a hereditary cancer syndrome

How do I make a genetic counseling appointment at Memorial Genetic Cancer Clinic?

You can either refer yourself or ask their doctor for a referral to genetic counseling. New patients interested in having a cancer risk assessment should contact the Clinical Cancer Genetic Cancer Clinical Program at 0212-314-6666 or 444 7 888.

Prepare for Your First Visit

Is there anything I can/should do before my appointment?

Your doctor has referred you for hereditary cancer risk assessment and genetic counseling to discuss your personal and/or family medical history. The medical information provided by you in the clinic are private and secure.

Prior to your visit, you may find it helpful to talk to your family members to find out as much medical information as you can about your family history. It may be helpful to gather information (current age or age at death, and general health history) on your family members.  Specifically, we will ask about your immediate family members, including your parents, siblings and children. We also want to know about your extended family members, including your aunts, uncles, cousins and grandparents, on each side of your mother and father’s family. 

For family members who have had cancer, you will need to obtain the following information on family members who had cancer:

  • Type of cancer (e.g., breast, colon, ovarian, etc.)
  • Age cancer was diagnosed
  • Current age. If deceased, age and cause of death (may or may not be from cancer)
  • Clarify whether the cancer was unilateral (e.g., one breast) or bilateral (e.g., both breasts)
  • Clarify whether the family member with cancer developed a second cancer. If yes, it is important to try to clarify whether the second cancer was a metastasis (spread from the first cancer), or a new primary cancer (new separate cancer)

We understand you may be unable to collect all the information about your family history of cancer. Genetic counseling will be based on the information that you provide.

What to Expect

What is genetic counseling?

Genetic counseling is a process of providing information and support about genetics and inherited conditions to an individual or family. The goal of genetic counseling is to provide clear and clinical relevant information about genetic risk factors in an atmosphere of support and education.

Who are genetic counselors?

Genetic counselors are health professionals with graduate degrees and experience in the areas of medical genetics and counseling. Most enter the field with a background in biology, genetics, nursing, psychology, public health or social work.

What can I expect during my first visit to a genetic counselor?

You will need to complete and bring the paper version of the Genetic Risk Assessment Questionnaire in Turkish or English to your first genetic counseling appointment. During your first visit, the genetic counselor will review your family medical history, and help you understand the role of genes in causing cancer. The genetic counselor will perform a cancer risk assessment based on the information you provide. We will discuss the chance that a risk for cancer might be passed through the genes in your family and discuss any genetic testing that could be helpful for your family. We will also give you a general estimate of your personal cancer risks. During the risk assessment, we will discuss appropriate screening and prevention for you and your family.

Appointment Questions

Can family members come with me to my first appointment?

You are welcome to invite anyone to come with you (family, friend, etc.) to your appointment, but you will be the main focus of the consultation.

How long is my first visit?

The first genetic consultation visit will usually last 60 minutes.

How many times will I need to come to genetics clinic?

Dr. Soley Bayraktar will discuss with you how often you may need to be seen again after the genetic test results are obtained. This often depends on follow-up of additional family history information, whether you or a family member decides to have genetic testing and the complexity of the situation.

Will a physician be present during my genetic counseling visits?

Dr. Soley Bayraktar will be present at all genetic counseling visits. The genetic counselor will consult with her about your medical and family history.

Medical Records

How do I obtain a copy of my genetic consultation notes?

Your patient service coordinator or genetic counselor can provide you with this form.

How do I obtain a copy of my pedigree?

A pedigree is the drawn family tree that you and the genetic counselor developed during your first genetics consultation. Pedigrees are available from the Genetics Cancer Clinical Program. Please contact your genetic counselor to obtain a copy.

Will the information discussed during the genetic counseling appointment(s) be part of my medical records?

Yes. This information is made available to your health care providers so they can make appropriate medical management recommendations and decisions. You will also be mailed a copy of the genetic consultation notes for your personal files.

Genetic Testing

What is genetic testing?

During your cancer risk assessment, the genetic counselor will discuss whether genetic testing is an option for you or your family to consider. Genetic testing involves analyzing a blood sample for specific changes in the DNA, or genetic information. The decision to have genetic testing is a personal choice that can be made at the time of the counseling visit, or at a future date.

Is genetic testing recommended for all patients?

Genetic testing is available for some families with a strong family history of certain types of cancer. During your cancer risk assessment, we will help you decide if genetic testing is right for you or your family. It is best to begin genetic testing with a family member who has had cancer or a precancerous condition that suggests susceptibility to cancer. The genetic counselor will discuss who the best person in your family is to consider genetic testing.

Will I need to fast before my blood draw for genetic testing?

No. There is no special preparation before you have your blood drawn for genetic testing. Patients typically have one to two tubes of blood drawn for testing. The genetic counselor will explain the process of genetic testing before you have your blood drawn to answer any of your questions and concerns.

How much does genetic testing cost?

The genetic counselor and Dr. Soley Bayraktar will determine the specific genetic test that is recommended for you and discuss the cost of testing prior to ordering any genetic testing. Some insurance companies may cover the cost of genetic testing. The cost of genetic counseling and tests will depend on the specific genetic test that is required.

How long will it take to get my genetic test results?

At the time of your blood draw, the genetic counselor will discuss with you the estimated length of time it will take the lab to analyze your sample. The range is usually from four to eight weeks. We will make an appointment for you to return at the appropriate time to discuss your genetic test results.

  1. Patient with a personal history of breast cancer diagnosed ≤45 years of age (no known family history).
  2. Patient with a personal history of TRIPLE NEGATIVE breast cancer diagnosed at any age.
  3. Patient with two breast primaries when first breast cancer is diagnosed ≤50 years of age
  4. Patient with a personal history of breast cancer diagnosed at any age, plus one or more of the following:
    1. Personal history of ovarian cancer
    2. Family history* of ovarian cancer
    3. Family history* of breast cancer diagnosed ≤50 years of age
    4. Family history* of male breast cancer
    5. Family history* of ≥2 relatives diagnosed with breast cancer at any age (<80 years old)
    6. Family history* of ≥2 relatives diagnosed with any of the following types of cancer <50 years old:
      • Thyroid cancer
      • Endometrial cancer
      • Sarcoma
      • Adrenocortical carcinoma
      • Brain tumors
      • Prostate cancer
      • Pancreatic cancer
      • Melanoma
    7. Ashkenazi Jewish ancestry
  5. Any male patient with a personal history of breast cancer
  6. Any member of a family with a known mutation.
  7. Any patient who is known to have a germline BRCA mutation and was tested at an outside facility.
  8. Family history* of cancer ONLY: If a first or second degree relative meets any of the above criteria, a referral can be considered.
    1. If a family member who has breast/ovarian cancer is living please consider referring that individual for genetic evaluation first.

*Family history should be all on the same side of the family, i.e. either maternal or paternal and includes first, second and third degree relatives.

December 2015: approved by Assoc. Prof. Soley Bayraktar; Dr. Yeşim Özdemir

Clinical Cancer Genetics Clinical Referral Guidelines

Strongly encourage referral:  

Patients with any of the following:

  • Medullary thyroid carcinoma
  • Pheochromocytoma/paraganglioma AND
    1. Family history of pheochromocytoma/paraganglioma OR
    2. If multiple OR
    3. If diagnosed under age 40
  • Malignant pheochromocytoma/paraganglioma at any age
  • Parathyroid carcinoma
  • Cribiform-morular variant of papillary thyroid cancer
  • Personal history of follicular thyroid cancer PLUS a personal or family history of breast cancer, endometrial cancer, and/or dermatologic manifestations of Cowden syndrome
  • Family history of a known mutation for a cancer predisposition syndrome

Patients with 2 or more of the following, or 1 AND a family history of 1 or more of the following:

  • Primary hyperparathyroidism
  • Entero-pancreatic endocrine tumors
  • Pituitary adenoma
  • Foregut carcinoid (bronchial, thymic, or gastric)
  • “Other” : lipomas/angiofibromas/collagenomas, adrenal cortical adenomas

Consider referral:

Patients with any of the following:

  • Pituitary adenoma diagnosed before age 25
  • Hyperparathyroidism diagnosed before age 40
  • Multi-glandular hyperparathyroidism
  • Multi-focal pancreatic endocrine tumors
  • Gastrinoma
  • Pheochromocytoma diagnosed after age 40
  • Familial non-medullary thyroid cancer
  • No personal history of cancer, but a family member who meets any of the above (Strongly encourage referral) criteria

December 2015: approved by Assoc. Prof. Soley Bayraktar; Dr. Yeşim Özdemir

Clinical Cancer Genetics Clinical Referral Guidelines

Strongly encourage referral: 

Patients with any of the following:

  • Prior tumor studies suggestive of Lynch syndrome (MSI-H and/or loss of staining for any mismatch repair protein by IHC)
  • Colorectal cancer diagnosed <50 years
  • Colorectal cancer diagnosed at any age AND first- or second-degree relative with any HNPCC-related cancers*, diagnosed <50 years
  • Colorectal cancer, regardless of age AND one or more of the following (Lynch syndrome-associated cancers due to mutations in MLH1, MSH2, MSH6, or PMS) in his/her personal history:
    1. Synchronous or metachronous colorectal cancer
    2. Endometrial cancer
    3. Sebaceous neoplasias
    4. Gastric, pancreas, ureter and renal pelvis, biliary tract, brain, or small intestinal   cancers
  • Multiple (> 10) adenomas, on a single colonoscopy
  • Hamartomous polyps, any number, occurring at any age (manifestations of Peutz-Jeghers syndrome, juvenile polyposis syndrome)
  • Diffuse gastric adenocarcinoma (linitis plastica) AND first- or second-degree relative with gastric cancer or lobular breast cancer (manifestations of hereditary diffuse gastric cancer due to mutations in CDH1)
  • Pancreas carcinoma, regardless of age, AND of Ashkenazi Jewish ancestry
  • Pancreas carcinoma AND personal or family history of pancreatic cancer
  • Pancreas cancer AND personal history, or first- or second- degree relative with breast cancer < 50 and/or ovarian cancer
  • Family history of a known mutation for a cancer predisposition syndrome

Consider referral:  

Patients with any of the following:

  • Colorectal cancer diagnosed >60 years AND first- or second-degree relative with any HNPCC-related cancers*, regardless of age
  • Multiple (>5) adenomas on a single colonoscopy, under age 50
  • Unusual polyp burden (young age at diagnosis, histology, number)
  • No personal history of cancer, but a family member who meets any of the above (Strongly encourage referral) criteria
  • Pancreas carcinoma and personal or family history of melanoma diagnosed under age 40 years

* HNPCC-related cancers include: colorectal, endometrial, ovarian, gastric, pancreas, ureter and renal pelvis, biliary tract, brain, small intestinal cancers and sebaceous gland adenomas and keratoacanthomas (revised Bethesda guidelines, Umar et al, JNCI 2004)

December 2015: approved by Assoc. Prof. Soley Bayraktar; Dr. Yeşim Özdemir

Clinical Cancer Genetics Clinical Referral Guidelines 

Strongly encourage referral:

Patients with any of the following:

  • High grade ovarian cancer diagnosed < 50 years (no family history needed)
  • Ovarian cancer* AND one or more of the following:
    1. Personal history of breast cancer
    2. Family history of ovarian* and/or pre-menopausal breast cancer and/or bilateral breast cancer and/or male breast cancer
    3. Family history of two or more relatives with breast cancer at any age
    4. Ashkenazi Jewish ancestry
  • Endometrial cancer, AND one or more of the following:
    1. Personal history of colorectal cancer, regardless of age
    2. First degree relative with colorectal or endometrial cancer at any age
    3. Any family history of colorectal or endometrial cancer diagnosed under age 50
  • Family history of a known mutation for a cancer predisposition syndrome

Consider referral:

Patients with any of the following: 

  • No personal history of cancer, but a family member who meets any of the above (Strongly encourage referral) criteria
  • Any high grade ovarian cancer
  • Endometrial cancer diagnosed <50 years
  • Personal or family history of follicular thyroid cancer, breast cancer, and/or dermatologic manifestations of Cowden syndrome

*Peritoneal and fallopian tube cancers should be considered as part of the spectrum of the Hereditary Breast and Ovarian Cancer Syndrome.

December 2015: approved by Assoc. Prof. Soley Bayraktar; Dr. Yeşim Özdemir

Identifying Patients at Risk for Hereditary Pancreatic Cancer

Finding patients who have germline mutations in the PALB2 and BRCA2 genes may provide valuable information about cancer risks to patients and their family members. The following "Red Flags" in a patient's personal or family history may indicate an increased risk for a PALB2 or BRCA2 mutation. Red Flags identify patients at risk for a PALB2 or BRCA2 mutation, for whom further clinical evaluation to determine appropriateness of genetic testing is warranted.

  • Pancreatic cancer patient with at least one close* relative with pancreatic cancer
  • Individual with two or more close* relatives with pancreatic cancer
  • Individual of Ashkenazi Jewish ancestry with a personal history of pancreatic cancer or a first-degree® relative with pancreatic cancer
  • A previously identified PALB2 or BRCA2 mutation in the family

*Close refers to first- or second-degree relatives.

®First-degree relatives include parents, siblings, children; second-degree relatives include grandparents, aunts/uncles, nieces/nephews

Pancreatic Cancer Risks

Cancer risks associated with a BRCA2 or PALB2 mutation

Mutations in genes BRCA2 or PALB2 increase the risk of specific cancers. Studies of unselected BRCA2 mutation carriers have documented up to a 7% risk for pancreatic cancer by age 80, but this risk may be considerably higher in BRCA2 mutation carriers where a family history of pancreatic cancer is present. Women with BRCA2 mutations have a risk of up to 84% for breast cancer and up to 27% for ovarian cancer by age 70. Male mutation carriers have up to an 8% risk of male breast cancer and up to a 20% risk of prostate cancer by age 80. Additionally, cancer survivors have an increased risk of a second primary cancer diagnosis.

Mutations in PALB2 have been identified in families with multiple cases of pancreatic cancer, but the exact risk for pancreatic cancer conferred by PALB2 mutations has not yet been established. The cumulative breast cancer risk among female PALB2 mutations carriers is estimated to be increased by 2-4 fold, which translates to an 18-35% risk of breast cancer by age 70 based on general female population risk of 8.8% to age 70.

Genetic testing identifies patients who have germline mutations in the BRCA2 and PALB2 genes. This information may be useful when developing risk-reducing strategies for these patients.

Managing Patients with Hereditary Pancreatic Cancer

If your genetic testing confirms the presence of a BRCA2 or PALB2 mutation, the following medical management options may help reduce cancer risk and may either delay the onset of cancer, detect cancer at an earlier, more treatable stage or even prevent it.

Positive PALB2 Gene Mutation Result:

Increased Surveillance for Pancreatic Cancer in Mutation Carriers

  • There are no standardized guidelines for pancreatic cancer surveillance, but screening techniques such as MRI, CT, EUS, ERCP and MRCP may be considered.
  • Monitor and/or modify lifestyle risk factors, including smoking, alcohol, diabetes and pancreatitis.

Increased Surveillance for Breast Cancer in Mutation Carriers

  • There are no formal breast cancer surveillance recommendations for patients with a PALB2 mutation. Due to the increased risk of breast cancer, surveillance could include initiating screening at younger ages, increased frequency of screening, and use of MRI or other modalities in addition to mammography, breast self-exams and clinical breast exams.

Positive BRCA2 Gene Mutation Results:

Increased Surveillance for Pancreatic Cancer in Mutation Carriers

  • There are no standardized guidelines for pancreatic cancer surveillance, but screening techniques such as MRI, CT, EUR, ERCP and MRCP may be considered.
  • Monitor and/or modify lifestyle risk factors, including smoking, alcohol, diabetes and pancreatitis.

Increased Surveillance for Breast Cancer in Mutation Carriers

  • Monthly breast self-exams starting at age 18
  • Annual or semiannual clinical breast exams starting at age 25
  • Yearly mammography starting at age 25
  • Yearly magnetic resonance imaging (MRI) starting at age 25 or individualized based on earliest case in the family

Increased Surveillance for Ovarian Cancer in Mutation Carriers

  • Annual or semiannual transvaginal ultrasound
  • Annual or semiannual blood test for CA125 beginning at age 25
  • Annual pelvic exams

Risk Reducing Medications for Mutation Carriers

  • Tamoxifen use has been associated with a reduction of 53% in the risk of a second primary breast cancer in contralateral cancers
  • Oral contraceptives, when taken for 6 or more years, have been associated with a reduction of up to 60% in the risk of ovarian cancer

Prophylactic Surgery in Mutation Carriers

  • Prophylactic mastectomy reduces breast cancer risk by at least 90%
  • Prophylactic oophorectomy reduces ovarian cancer risk by up to 96% and breast cancer risk by up to 68%

Doctors of Department