Protecting Families: Discussing Germline and Cascade Testing

At the OneOncology APP Symposium, Michael Adashek, DO, of United Urology Group, emphasized the evolving role of oncology and urology practitioners in managing hereditary cancer risks.

For Adashek, the discovery of a pathogenic mutation through germline testing is not just a clinical finding for the individual patient — it is the beginning of a critical dialogue regarding family health and long-term prevention.

The emotional stakes of such findings are often high. Adashek noted in an interview with Oncology Nursing News that while patients are concerned about their own diagnoses, their focus shifts rapidly when the possibility of hereditary risk arises. "I joke in my presentation what I hate more than cancer [is] cancer in families," Adashek said, adding that "very few things matter more to parents than if their kids are at risk of cancer."

This paternal or maternal instinct becomes a primary driver in the clinical decision-making process. According to Adashek, when a hereditary mutation is identified, patients are eager to act. "They want to know: Are their kids at risk? They want to know: how quickly can I get them tested?"

The urgency reflects a fundamental shift in the patient-provider dynamic, where the goal expands from treating a single patient to safeguarding an entire lineage.

To meet this demand, practitioners must be strategic in their choice of diagnostic partners. Adashek highlighted the importance of selecting germline testing companies that facilitate cascade testing — the process of testing blood relatives of an individual documented to have a pathogenic gene mutation.

"There are many different germline testing companies out today and many that we choose specifically because they do offer cascade testing," he explained.

This choice is rooted in the patient’s own priorities. Adashek observed that "if you ask [patients] where if they care about what happens to them or their kids, almost all of them pick their kids first."

Consequently, the practitioner's ability to provide easy access to family testing is a key component of high-quality oncological care.

Adopting this family-centric approach redefines the relationship between the medical provider and the patient. It moves the clinician beyond the role of a traditional prescriber into that of a "partner" in family health.

Adashek asserted that in this context, "your job as a medical practitioner is to defend both the patient and their family." By facilitating genetic sequencing down the family line, providers act as a sentinel against future diagnoses.While receiving news of a cancer-causing gene is never ideal, the ability to identify it provides a roadmap for the family. As Adashek noted, "Nobody wants a cancer-causing gene. But if you do find it, what do they want to know about it?" The answer lies in the practitioner's ability to provide clarity, facilitate cascade testing, and ultimately, offer a layer of protection for the next generation. By viewing the patient and family as a single unit of care, advanced practice providers can significantly impact the trajectory of hereditary cancer.