Date:
Patient:
MRN:
Clincian: (Genetic Counselor, Oncologist)
Reason for Visit:
Evaluation for potential HBOC risk
Review of family history and cancer diagnoses
Discussion of genetic testing options and cancer risk management strategies
History of Present Illness:
Briefly describe the reason for referral (personal or family history of cancer):
Personal history of breast or ovarian cancer, particularly at a young age (<50 years old)
Strong family history of breast, ovarian, pancreatic, or prostate cancer in first-degree relatives (parents, siblings, children)
Male breast cancer in the family
Known mutations in BRCA1 or BRCA2 genes in a family member
Past Medical History:
Previous diagnoses of breast or ovarian cancer (if applicable)
Other relevant medical history (e.g., personal history of benign breast disease)
Family History:
Detailed family history focusing on:
Cancers diagnosed in blood relatives (parents, siblings, children) including type of cancer, age at diagnosis
Ethnicity (relevant for certain HBOC risk factors)
Social History:
Age at menarche (first menstrual period)
Age at first live birth and number of children (if applicable)
History of breastfeeding
Physical Exam:
Performed as part of a cancer screening visit if indicated.
Assessment:
Based on the family history and personal cancer diagnoses (if any), assess the patient's risk for HBOC using standardized models (e.g., Gail Model, BRCApro).
Discuss the rationale for genetic testing considering the patient's risk score and family history details.
Plan:
Outline the plan based on the patient's risk assessment and preferences:
Genetic Testing:
Discuss the types of genetic testing available (BRCA1/BRCA2 gene testing, multi-gene panel testing).
Explain the benefits and limitations of genetic testing, including the possibility of negative or uncertain results.
Obtain informed consent for genetic testing if the patient chooses to proceed.
Cancer Risk Management:
Depending on the test results and individual risk factors, develop a personalized cancer screening plan (mammography, ovarian cancer screening) with appropriate starting ages and frequencies.
Discuss risk-reduction strategies such as hormonal therapies (tamoxifen) or prophylactic surgery (salpingo-oophorectomy, bilateral mastectomy) for high-risk individuals.
Advise on healthy lifestyle modifications (diet, exercise) to potentially reduce cancer risk.
Consider mentioning referral to a genetic counselor for pre-test counseling and a multidisciplinary team (oncologist, surgeon) for risk management discussions.
Prognosis:
Briefly discuss the implications of a positive genetic test result for HBOC cancer risks.
Emphasize that a positive test result does not guarantee developing cancer, but allows for more proactive management.
Offer reassurance that HBOC is manageable with early detection and appropriate interventions.
Education:
Document any education provided to the patient regarding:
The nature of HBOC and its genetic basis
The inheritance pattern of HBOC mutations
The benefits and limitations of genetic testing
Cancer screening recommendations and risk-reduction strategies based on individual risk profile
The availability of support groups for individuals with a family history of cancer or a positive genetic test result
Notes:
Include any additional relevant information not covered above, such as the patient's understanding of the information presented, emotional response to the possibility of HBOC, and any concerns they may have about genetic testing, cancer risk, or preventive measures.
Address the potential emotional impact of genetic testing and offer support or referral for mental health services if needed.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a genetic counselor or oncologist with expertise in HBOC for risk assessment, genetic testing recommendations, and development of a personalized cancer risk management plan.