Identification of Cancer Risk During Prenatal Genetic Counseling Sessions: Evaluation of Frequency and Current Practice Protocols

This study determined how often cancer is reported in prenatal three-generation family histories at our center. It also examined if there was a change between the years 2010 and 2016, given changes noted in cancer awareness over the last 10 years. Using a retrospective chart review, we found that 59% of 437 prenatal pedigrees from 2016 reported cancer, a 19% increase from 2010. Using a generalized cancer scoring system, there was a 48% increase in maternal high-risk, 175% increase in maternal intermediate-risk, 16% increase in maternal low-risk, and a 43% increase in paternal low-risk cancer families between 2010 and 2016. This study also assessed current practice protocols of prenatal genetic counselors to identify if there is uniformity in how they evaluate and respond to families with reported cancer history. A survey of 104 prenatal genetic counselors revealed that the majority ask about age at diagnosis when cancer is discussed, but only 53% address cancer every time they take a three-generation family history. When given sample pedigrees, prenatal counselors responded differently to maternal vs. paternal lineage high cancer risk; 24% elected to refer to cancer genetic counseling for a paternal high-risk family compared to 62% for a maternal high-risk family. Taken together, the results of this study support the importance of obtaining comprehensive three-generation pedigrees that include cancer in the prenatal setting and developing institutional protocols for prenatal counselors to evaluate, respond, and relay information regarding cancer genetic risk assessment to prenatal patients