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In Reply:

Department of Preventive Medicine and Public Health, Creighton University, Omaha, Nebraska

I deeply appreciate the opportunity to respond to the letter written in response to my article titled "Hereditary Breast-Ovarian Cancer at the Bedside: Role of the Medical Oncologist."¹ I am a practicing medical oncologist, and the subject of cancer genetics has become of such keen importance to the entire physician community that we emphasized this in the Physician Responsibility section on page 741 of the article. We stated, "Recent advances in knowledge about cancer genetics have increased significantly the responsibility of all physicians and in particular, medical oncologists; however, it is virtually impossible for physicians to become fully aware of each new scientific development that affects diagnosis, surveillance, management, and DNA testing recommendations."

Thus, because of the highly specialized nature involving the genetics of virtually all forms of cancer, we went on to recommend that in certain situations, referral to specialized practitioners, such as genetic counselors and medical geneticists, should be strongly encouraged.

My coauthors and I agree fully with the remarks of our medical oncology colleague, as he appropriately stresses how the medical oncologist "interested in cancer genetics can provide guidance, classification, reassurance, and direction based on firsthand knowledge of the devastation of the cancer diagnosis, and the situation of the unpredictability of the disease, and the understanding of the limitations of screening." The fact of the matter is that hereditary cancer syndrome diagnosis implies a crucial role for molecular genetics, with respect to its diagnostic potential, as in the case of BRCA1 and BRCA2 in hereditary breast cancer. This therefore mandates that the medical oncologist be kept fully abreast of this rapidly evolving discipline of hereditary cancer.

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author indicated no potential conflicts of interest.

REFERENCE

1. Lynch HT, Snyder CL, Lynch JF et al: Hereditary Breast-Ovarian Cancer at the Bedside: Role of the Medical Oncologist. J Clin Oncol 21:740–753, 2003[Abstract/Free Full Text]

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