Genetics Hold Promise, Challenges for Cancer Care

Still, certain "commonalities" could simplify things. Futreal pointed out that even though hundreds of genes can go awry and cause a cancer, many of these mutations will target the same cellular pathway. So, treatments that repair those broken pathways could fix a host of tumor types, he reasoned.

Today, however, only a small minority of cancer patients are directly benefiting from gene-based diagnostics or treatments. Those include women who carry theBRCA 1andBRCA 2breast cancer mutations, patients with chronic myelogenous leukemia (CML) who can take Gleevec, and early stage lung cancer patients who may soon benefit from those new prognostic tests.

And even when Americans find out that theydocarry a certain gene posing an added risk, finding a qualified genetics counselor to sort it all out can be tough. There are only a handful of these experts in Lichtenfeld's hometown, Atlanta, he said, and they're practically unheard of in smaller centers.

"Most physicians simply aren't familiar with all the implications of assessing a woman's risk for breast cancer, for example, [or] of understanding all the genetic issues," Lichtenfeld noted. "So, I think that our theory right now is better than our practice. Our practice clearly needs to get better."

Nevertheless, things are greatly improved from decades past, when a patient with a family history of cancer was simply told to watch and wait and hope.

In the case of theBRCA 1andBRCA 2genes -- thought to cause up to 10 percent of breast cancers -- women now have real options to cut their risk, Lichtenfeld said. Using high-tech tests to spot the genes, women can make tough but potentially lifesaving decisions to have a breast removed or to take anti-cancer drugs such as tamoxifen to cut their odds for cancer by up to 80 percent.

Other tests aimed at spotting theHER-2cancer gene and its product protein can dictate whether a patient's breast tumor will react favorably to the drug Herceptin.

"Many of these decisions aren't any easier than they were in the past, but at least now, they are much better informed," Lichtenfeld said. "And, looking into the future, this is going to become so much more a part of our diagnosis -- our ability to diagnose before we evenseecancer. Typing the kind of cancer a patient has, too. And it's all going to become a huge part of cancer treatment."

More information

Find out more about cancer genetics at the American Cancer Society.

SOURCES: Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Andrew Futreal, Ph.D., co-leader, Cancer Genome Project, Wellcome Trust Sanger Institute, Cambridge, England