ASCO 2025 | Incorporating genomic profiling and hereditary cancer risk assessment into clinical practice

It’s one of the most common questions that I get as a medical oncologist when a patient’s diagnosed with either early or late-stage cancer. They often think, why did I develop this cancer, and are my siblings, sons, daughters also at risk of developing this cancer? So I think first it’s very important, even though there’s a million different things going on in that first clinic visit, to take a very detailed family history. What other types of cancers do we see? Are there a history of breast cancer, a history of prostate cancer, a history of pancreatic or ovarian cancer? Those are the cancers that tend to have a hereditary risk to them. And if there is a strong family history, then we talk about doing germline testing, so panel-based testing, looking for some of the most common genes that put patients at risk for developing genitourinary cancers. In particular, in prostate cancer, we’re really trying to make a push for all patients with metastatic prostate cancer or with high-risk localized prostate cancer to do germline genetic testing because we are often finding BRCA1, BRCA2 mutations, other DNA damage mutations, or even Lynch syndrome genes in those patients. And I always say that sometimes can affect that patient’s treatment. We now have PARP inhibitors, which target the genetic vulnerability of patients with BRCA1, BRCA2 mutations in the metastatic setting. It also may have implications for doing screening. So if we have a patient with prostate cancer who is found to have one of these mutations, we now have screening for male breast cancer, for pancreatic cancer, for skin cancer. So it can really inform not only how we care for that patient, but also that patient’s entire family.

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