Interview with Dr. Codori
In the Spotlight

Ann Marie Codori, Ph.D. is Assistant Professor at the Department of Psychiatry and Behavioral Sciences and has a joint appointment in the Department of Oncology, Johns Hopkins School of Medicine. Dr. Codori serves as a consultant to MACGN providing expertise in psychology. She is the Principal Investigator of a genetic testing study on Hereditary Nonpolyposis Colorectal Cancer.

In your studies, what have you been learning about how people view genetic testing for colon cancer?

People come for genetic testing with the idea that they are doing something to avoid colon cancer. They have greater levels of distress about colon cancer than those who choose not to be tested, but, generally, the patients feel that colon cancer is treatable through surgery, for example. Compared to those who decline an invitation to be tested, they tend to be information seekers who have a higher perceived risk for colon cancer. They are also more likely to follow through with their doctor’s screening recommendations.

How do genetic test results for colon cancer impact the lives of those who are tested?

Generally, the impact on people who have colon cancer gene testing is due to a combination of genetic counseling and the test result. As we counsel our patients before and several times after testing, we have the opportunity to evaluate the effect of the testing process on their subsequent colon cancer screening behavior. For example, some people receive inconclusive results (not conclusively positive or negative for a mutation), so we recommend cancer screening based on the number of family members who have had colon cancer, rather than on the gene test result. For some, an inconclusive result provides relief simply because the alternative would have been a positive test result. There is concern that people who see an inconclusive result as "good news" may be "falsely reassured" about their colon cancer risk and then reduce their future cancer screening. Preliminary analyses suggest that screening does not decline after an inconclusive result, despite drops in perceived risk for colon cancer and fears about getting colon cancer. In fact, it appears that the persons who are getting regular screening are more likely to feel "relieved" after an inconclusive result.

What kinds of research efforts would you like to see in colon cancer gene testing?

I would like to see research on the efficacy of genetic counseling for cancer. We intend to evaluate the possibility of influencing cancer screening behavior in persons who are not eligible for genetic testing, but have a higher risk for cancer because they have a first-degree relative (parent, sibling, child) with colon cancer. We would like to know if counseling people about the preventability of colon cancer prompts them to get a colonoscopy. Although genetic counselors have traditionally taken a "non-directive" approach, we would like to study a more "health promoting" approach in cancer genetics counseling wherein genetic counselors make screening recommendations

What role would you like to see MACGN play in educating people about genetic counseling and testing?

MACGN should create mechanisms to teach primary care providers to take family histories, to make appropriate referrals for patients who have a family history of cancer, and to identify various hereditary cancer syndromes. MACGN should provide feedback to participants on the latest developments in cancer genetics relevant to them and continue to encourage people with cancer family history to become part of the Network.