In Brief 

• The Prevention and Risk of Cancer Assessment (PARCA) program helps to identify an individual’s risk of cancer, make the person aware of that risk, and then make that person aware of what measures they can take to prevent the disease.
• PARCA takes into account an individual’s genetic, lifestyle and environmental risk factors when determining a person’s risk of developing cancer, as well as providing recommendations for lowering that risk.

Are you concerned about your cancer risk? Does this concern stem from any or all of the following factors - your family history, personal habits and lifestyle, and occupational exposures?

If so, then you should turn to the Crozer Regional Cancer Center’s Prevention and Risk of Cancer Assessment program, or PARCA. The program, which began in 2000, is an excellent resource for people who want to take a proactive approach to their health by becoming more knowledgeable about their risk of developing cancer.

“The concept of PARCA is to identify an individual’s risk of cancer, make the person aware of that risk, and then make that person aware of what measures they can take to reduce the risk and maybe prevent the disease,” says Raymond Vivacqua, M.D., chief of the Division of Hematology/Oncology at Crozer-Chester Medical Center, medical director of the Crozer Regional Cancer Center and co-director of PARCA services. “We put emphasis on prevention as well as early detection and offer recommendations to the client for lowering their risk by taking into consideration their genetic, environmental and personal habit risk factors. PARCA is unique in that we look not just at genetics, we look beyond genetics.”

While open to anyone, most clients come to PARCA by way of a physician referral. Virginia Speare, Ph.D., oncology genetics counselor and director of PARCA Services, receives the physician’s referral. Upon receipt, she contacts the client and sends out information about PARCA, including family medical history forms. Once Speare has possession of the client-completed family history, along with other appropriate paperwork, Speare contacts the client to set up an appointment. The appointment, Speare says, includes a medical history, a discussion about inherited and familial cancers, and a discussion of the factors that determine an individual’s risk for cancer over his or her lifetime.

“One of the biggest misconceptions people have is the actual percentage risk they have of developing cancer based on their genetics,” Speare says. Just a small portion of cancer is actually inherited, meaning that a mutation carried in reproductive cells was passed on from one generation to the next, and is present in cells throughout the body. Most cancers occur sporadically, and come from random mutations that develop in body cells during one's lifetime - either as a mistake during cell division or in response to injuries from environmental agents such as radiation or chemicals. Genetic testing analyzes certain genes for inherited mutations associated with diseases, and in PARCA’s case, certain types of cancers. A person’s chances of developing cancer increases if certain mutations are found within these specified genes.

During this first appointment, most clients also meet with a physician and have a targeted physical examination. If a client has a strong family history of cancer, such as a female client’s mother, grandmother, aunt and sister all developing breast cancer at a young age, the client may be offered genetic testing.

“There are certain guidelines we have when determining if a client is possibly high-risk, and genetic testing is appropriate,” says Speare. “One, is the result of the genetic testing going to change the client’s medical management, and two, is there a high probability of finding a mutation ?”

For clients who do have blood drawn for genetic testing, Speare counsels them about the responsibilities that may come with the results of the test, such as alerting family members that they, too, could possibly have a high-risk of developing cancer.

Once Speare has the results of the genetic testing, the client comes back in for a second appointment to discuss the results. If the results indicate certain gene mutations, preventative strategies are devised for the client as a way of hopefully preventing the onset of the particular type of cancer. When no mutation is found, recommendations are made based on the client’s detailed family history and an assessment of personal risk factors.

Speare warns that although genetic testing can provide a good indication of genetic mutations, it does not pick up every mutation.

“It’s not full-proof,” says Speare.

For all patients, communication does not end once the client has come in and met with a counselor or a physician.

“It’s a two-way conversation between us and the client in that we put out information in the form of an annual newsletter which alerts clients about new findings in regards to risk factors, genetic testing and lifestyle, and that we also send out yearly questionnaires to our clients, which allows them to provide us with feedback and new information or developments in their life which may warrant a re-investiagation of their risk by one of our genetic counselors,” says Vivacqua.

This open dialogue between PARCA and its clients is critical due to the relationship many types of cancer have between early detection and curability rates, Vivacqua says.

“The difference between a very early detection and a little later detection can mean the difference between 90-95 percent curability and under 50 percent curability, respectively,” says Vivacqua.

As genetic testing and the influences of life-style, personal habits and environmental factors are integrated into a patient’s medical care, the PARCA program will aide physicians in their efforts to detect cancer early and possibly prevent cancer.

“PARCA services will become increasingly important in the care of patients and families as we move forward because more genes associated with cancer risk are being discovered and our understanding of environmental risk factors is increasing.” says Speare. “It’s important that there is a link between what we know about the genetics of cancer and the clinical management of patients who are diagnosed with cancer or at risk for developing cancer.”

For more information about PARCA, call (610) 447-2678.