Genetic Testing

Doctors generally do not rely on genetic testing to screen for, or make an initial diagnosis of, colorectal cancer. However, under some circumstances genetic testing is appropriate. It may be offered to high risk families to determine an individual's risk for developing certain genetic forms of colorectal cancer.

For example, there is a test that can be used to detect the variant APC gene (a variation of the APC Gene), which predisposes some people to developing familial adenomatous polyposis. This test, which is performed on a small sample of blood, does not rule out mutations that cause other forms of hereditary colon cancer.

Should I Be Tested for the APC Gene Mutation?

The Cleveland Clinic Risk Assessment Program suggests that any person of Ashkenazi Jewish descent may consider genetic counseling and testing if there is a personal or family history of colon cancer or pre-cancerous polyps. People of Ashkenazi Jewish descent without a family history of colorectal cancer may want to consider genetic counseling to determine the value of testing, given their circumstances.

How Should I Interpret the Results?

A positive test result means that you have an increased risk of developing colorectal cancer in your lifetime. If you already have had colon cancer or polyps, it may affect screening recommendations. This test does not detect the presence of cancer or polyps.

If you test negative for this gene variant, it means that you do not have this specific cancer risk. But, you may still have a mutation in another gene that causes hereditary colon cancer. Risk may be evaluated through genetic counseling, where family history, lifestyle, and other issues may be discussed.

What Should I Do If I Test Positive for the APC Gene Variant?

Early diagnosis is important for preventing colorectal cancer. At this time, experts have made the following recommendations for people who test positive for the APC gene variant:

• People with a positive gene test should have a routine colonoscopy every 1-2 years, beginning at puberty.
• People with a personal history of colon cancer or polyps should consider a colectomy; otherwise, screen with endoscopy every 1-2 years.
• Relatives of people testing positive for this gene mutation should consider genetic counseling and testing.

Note: These recommendations may be subject to change, based on specific family history information. It is important to talk with your doctor to determine the most appropriate screening practice for you.

Where Do I Go to Get the Gene Test?

The test currently is performed at only a few centers throughout the country. The Cleveland Clinic Foundation offers genetic counseling and APC gene testing for people of Ashkenazi Jewish descent.

Is the Cost Reimbursed by Insurance?

Some insurance providers cover genetic counseling and genetic testing, while others do not. Check with your provider about coverage before having the test performed.

Could I Be Denied Health Insurance Coverage Based on the Test Results?

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents insurance companies from denying health insurance based on genetic information, and prevents them from using genetic information to demonstrate that a health condition existed before application was made for insurance. In addition, many states have passed laws or have legislation pending to address insurance concerns.

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.