Genetics transform breast cancer screenings

Podcast: Genes can share clues about cancer history and risks, says Larissa Risty

Genetics transform breast cancer screenings

Episode Transcript

Jacqueline Palfy (Host): Hi, I’m Jacqueline Palfy and I’m here with Sanford Health News. Today our guest is Larissa Risty. She is a senior genetic counselor with Sanford Health. Hey, Larissa.

Larissa Risty (Guest): Good morning. How are you?

Host: I’m great. Thanks for being here today.

Risty: Of course.

Host: So, you and I have talked to each other quite bit over the past few years about the world of genetic counseling. Tell me a little bit about how you got into that field. It’s pretty new.

Risty: Right, sure. So, I was actually on an engineering track in undergrad. Really have always liked science and math and have always been where I wanted to go in a career. But after having a few internships, I realized that engineering was you sat, and you designed, and you didn’t have a lot of human interaction except for your kind of nerdy counterparts that worked with you. And I enjoyed that. But also kind of wanted a job that would have a little bit more one-on-one time with an individual.

And I actually started doing Google searches looking for things that could potentially tie that things in —

Host: What do you Google for that? “Talking to people job.”

Risty: Right.

Host: So, you stumbled onto genetic counseling as a career and it’s a fairly new field and we talk a lot in the state of South Dakota about brain drain. You know you hear about that a ton and whenever I hear that I think that’s not my company. Sanford is hiring all kinds of people in very highly skilled professions including genetic counseling. For folks who might not know exactly what that entails, can you tell me a little bit about it?

Risty: The profession in general?

Host: Absolutely. Not the brain drain. You already came back. We’re happy to have you.

Risty: Yeah, absolutely. So, genetic counseling is a master’s program first of all. So, two-year master’s with the summer in between the two academic years and you actually are trained in multiple areas of genetics with the idea then that you can come out and some individuals are kind of general genetic counselors who work in multiple different areas. The primary areas are going to be in prenatal high risk OB genetics, pediatric genetics, and then cancer genetics.

Now there’s a bunch of kind of subspecialties that are breaking off from that, but that’s kind of the three main areas that you would be trained in and you have clinical rotations through all of those. And really, it’s a profession where you are trying to take that medical information, that scientific information and make it understandable for a family. So, you work a lot with just helping them to understand what’s going on, breaking things down and helping them to think through how disease can be passed through families, how genes can impact the way that our body functions and what the result symptomology can kind of be there.

Host: We talked a little bit about how just because you might go and talk to a genetic counselor, that doesn’t mean that you have to have any kind of testing done. But this is someone who can really help you understand why you might want it and why you might not and what you do with the information, right?

Risty: Absolutely. A lot of the consults that we have don’t end in actual genetic testing. But it can be moreso information for the family about again how diseases pass through families, what their risk might be.

I specialize in cancer genetics so working through kind of if there’s been certain types of cancer present in family members, what does that mean for you? Does that put you at higher risk? Are there differences in the way that you might screen for that type of cancer in your lifetime?

So, all of those conversations can happen without genetic testing even being done.

Host: And again, this is something that tells you if you are more or less likely to get something, not if you have it. Correct?

Risty: Absolutely. So, specifically in cancer, when you carry a genetic predisposition as we call it, for a certain type of cancer, that does not mean with 100% certainty that you are going to develop that disease in your lifetime. Just that you are at much higher risk than the average person.

Host: And so then you might want to change some things in your lifestyle if you can. I mean some of those things would contribute as well.

Risty: Absolutely. That’s all part of that conversation that we have. What are the things that — what are your options to help to reduce risk as much as possible. Are there differences again in the way that you might screen for that type of cancer starting earlier, screening more frequently, et cetera.

Host: It’s pretty — what’s it like to talk to people? Tell me a little bit about like the first couple times you did this. Was it what you expected? Or — it’s such an intimate conversation.

Risty: Right. And it’s so different from patient to patient. I mean I think that’s what I really enjoy about my job. Everybody has a different personality. Everybody has a different way of understanding information. So, no consult is the same.

You can talk to sisters in two different consults and have entirely different conversations even though they are related and have the same family history. So, I think the variety and that human interaction is what I really enjoy.

Host: So, you got exactly what you wanted from your Google search. Thanks Google. So, you talk a little bit about different kinds of cancer, and I know that you work a lot with breast cancer. So, tell me what kind of testing is available and then what Sanford offers for women in that field. I shouldn’t just say women. Because can men get tested for breast cancer too?

Risty: Absolutely they can, yeah. So, Sanford has kind of a variety of different services to help families that have had breast cancer present in individuals. One of the first places you can kind of go is of course to your primary care doctor, talking about that family history and there are kind of triggers, early onset disease in a family, multiple family members that might trigger that referral to maybe either a genetic counselor to start with.

That conversation of taking the family history, understanding what’s gone on and then getting into what we were talking about a little bit earlier. What do we do about this now that you have this family history?

Sanford also has programs like our Breast Specialty Clinic. So Edith Sanford Breast Specialty Clinic is a clinic that an individual can actually have kind of her breast care centered in that clinic.

So, if she has risk factors for breast cancer, including family history, she might come — her initial consult, she would actually visit with a genetic counselor and then she could be followed in that clinic annually by a nurse practitioner who would do a clinical breast exam and just kind of keep up to date on any changes for her and her family to make sure that again, screening is being ordered effectively for her.

Host: Because of that family history.

Risty: Exactly.

Host: You know when we think about our grandparents and it’s changing, right? Like my – I’m older than maybe some of our listeners, but you might not always know what your grandmother died of. People didn’t always talk about it as much. So, you may not have any idea that some of this is in your family, right?

Risty: We talk about that regularly. Some individuals feel shy to come in and talk about family history because they really feel like, I haven’t gotten that much information from my family, I don’t really know what everybody had, and they just said they had cancer.

But I don’t even know really what type of cancer they had or what age they were when they were diagnosed, and we completely understand that. The generations before us were very closed lipped about medical information. They didn’t share quite as much in a lot of situations.

Host: And didn’t know as much. Not as much to share.

Risty: Right. So, in those cases, we just work with what we have. What you know is what you know and if you know well my grandmother had some type of cancer, I’m not sure what it was, but then I also know that my aunt on that side of the family did indeed have breast cancer at age 50.

We work with the information that we have and try to estimate as best we can what might be the best screening routine for you.

Host: Absolutely. Thank you so much for coming on today to talk with us.

Risty: Absolutely. Thank you.

Posted In Cancer, Genetics, Imaging, Innovations, Research, Specialty Care