The Health series is presented by AdventHealth

A conversation with Melanie Knight, APRN-C, a board-certified Family Nurse Practitioner specializing in hereditary cancer risk at AdventHealth Cancer Institute Shawnee Mission. 

Over the past century, our discovery of the human genetic code has led to greater understanding of how our genes impact our health.  

In 1953, James D. Watson and Francis Crick worked together, with help from Rosalind Franklin, to discover the structure of DNA. A generation later in 1988, a special committee of the U.S. National Academy of Sciences outlined the original goals for the Human Genome Project, which included sequencing the entire human genome. The resulting project aimed to determine the order of all three billion chemical base pairs (A, T, G, and C) that make up human genes and provide this information to researchers around the world. By 2003, they had found 92 percent of the human genetic code. By 2022, the Telomere-to-Telomere (T2T) consortium announced that it had filled in the remaining gaps and produced the first truly complete human genome sequence.   

If we know the specific genes that are responsible for higher cancer risks, we can do something about it. This opens the door for medical professionals to provide comprehensive genetic risk assessments and personalized care for individuals with a family history of breast, ovarian, colon, pancreatic, or prostate cancer.

Melanie Knight, APRN-C, CGRA, High Risk Oncology, AdventHealth Cancer Institute Shawnee Mission explains. 

Melanie Knight, APRN-C

If there is a genetic cancer risk in a patient’s family, when do you advise the patient to come in for a risk assessment or testing?

We look for family history patterns:

Multiple relatives with cancer: if the patient has more than one relative on either side of their family who has had cancer, especially at an early age, this is a key indicator for considering genetic testing. 
A history of cancer that spans multiple generations increases suspicion for a hereditary cancer syndrome.
A rare or unusual cancer, like pancreatic, ovarian, or male breast cancer, may be a clue for genetic predisposition.
Early onset cancers before the age of 50 may signal the presence of an inherited genetic mutation.
Other key signs could be: cancer in close family members (parent, siblings, children), a personal history of cancer (especially if at a younger age), multiple types of cancers in the same individual (breast and ovarian), Ashkenazi Jewish heritage (higher risk of BRCA1/2), or those with a known mutation in the family (BRCA1/2, Lynch syndrome, etc.).

What is involved in the process? How long does it take? Is this usually covered by insurance?

The process is quite easy. For breast cancer risk, I ask the patient questions regarding their family history along with their hormonal history to find their percentage of risk. If that number is over 20 percent, then they are considered high risk. From there, the patient is informed of the process for the office visits, possible genetic testing, and scans to aid in monitoring the patient. 

The first appointment can take up to one hour and subsequent appointments are 30 minutes. Genetic testing is an easy lab visit and results may take up to four weeks to be completed. Insurance covers high-risk appointments but may not cover the entire cost of a genetic test. Mammograms, as long as they are routine, are covered by insurance, but diagnostic mammograms and breast MRIs may not be completely covered.

How do you help patients understand and manage their breast, ovarian, colon, pancreatic, or prostate cancer risk? 

Helping a patient understand and manage their risk for breast, ovarian, colon, pancreatic and prostate cancers—especially when there’s a family history or genetic predisposition—requires a multi-faceted approach. The key lies in clear communication, shared decision-making, and offering actionable steps that empower the patient to reduce their risk and take preventative measures. Lifestyle changes are a factor in decreasing your cancer risk: eating a Mediterranean diet along with decreasing your red meat intake and increasing your fish intake, smoking cessation, alcohol intake of no more than four drinks a week for women and seven drinks for men, and exercise a minimum of three hours a week, including weight lifting. Explaining screenings for early detection is very important and helps find a cancer when it is most treatable. Addressing fears related to high risk is also very important.