We are proud of Sarah Primeau-Keilman
Day in the Life- Testing for Peace of Mind
What Does a Cancer Genetic Counselor Do?
As told by Within editor Katie Halloran
Organized for the day with her pink folders for her patients, Saint Mary’s Cancer Genetic Counselor Sarah Keilman meets me in the morning to preview her day. A one-person department, Keilman sees herself as an integral part of The Lacks Cancer Center team, working with the oncologists and surgical staff to provide patients information about genetic testing, coordinating the tests between Saint Mary’s lab and the labs around the nation that perform the genetic tests, and following up with patients on whether or not they have a genetic mutation.
Since June 2011, Keilman has been working at The Lacks Cancer Center,providing patients with information regarding the genetic testing, including which tests they may qualify for and which ones would be reimbursed by Medicare or their insurance.“Without insurance, the initial genetic test for hereditary breast and ovarian cancer syndrome costs $3,400,” said Keilman.
Patients come to Keilman in a variety of ways. Some are self-referrals, who wish to find out if they have a hereditary condition that could be passed on to their family members, while most are referred by the cancer center and from Advantage Health physicians, but she has begun receiving some patients from Mercy Health Partners, as their site doesn’t have a genetic counselor.
“Most of what I see at is the BRCA-1 and BRCA-2 screening for our Comprehensive Breast Center. Since we have known for 15 years that these genes work to suppress breast cancer tumors, it’s the most well-known and commonly ordered test,” said Keilman. She has noticed an increase with colorectal hereditary testing as well, thanks to Dr. Larry McCahill’s referrals.
Genetic testing is available for a variety of cancers, including, but not limited to,:
- Some brain cancers and
A master’s degree-trained professional, a genetic counselor can order the tests and is also trained in the psychological aspect of dealing with patients who are undergoing the tests. Knowing much about the genes and why they do what they do, Keilman is poised to answer any question that comes up.
Her first client for the day is a breast cancer survivor, anxious to undergo the testing, as she worries about her daughter’s and son’s propensities for cancer. A 30-year survivor, she was referred to Keilman due to her young age of being diagnosed with cancer. Keilman first begins with “tell me about your health history,” and listens to the patient, who remembers more in person than what she had filled out on the forms. Keilman then directs the patient to discuss her family’s health history while she takes notes.
Keilman draws a family tree featuring each grandparent, parent, sibling, cousin, aunt, uncle and children and grandchildren of the patient, and indicates which ones have had cancer. “This helps me see the trends within the families, when it’s simply illustrated,” said Keilman. Several of the patient’s family members had developed cancer at a young age. “This shows to me that your case is strong enough to move forward with testing, and that it would be covered by Medicare,” says Keilman to the patient.
After discussing all the options, the patient eagerly wants to move forward with the test. “I want to find out, so I can help the rest of my family, and especially my daughter,” the patient tells Keilman.
Keilman escorts the patient down to the Stat Lab in The Lacks Cancer Center, where she gets her blood drawn for Keilman to send it to Salt Lake City, Utah, where the testing will occur. The results will take two to four weeks to come back to Keilman, who then will tell the results to the patient. She is assisted by Phlebotomist Dawn Detweiler, who “loves working with Sarah. She is such a joy to be around.”
Keilman’s second patient for today has been recently diagnosed, and was referred by Saint Mary’s breast center surgeons. Unlike the first patient, after looking at her family history and her own health history, there was nothing to indicate to Keilman her cancer was hereditary. “We typically look for three things – young age of onset, the cancer to be on both sides of your body, and more than two family members to have the cancer,” explained Keilman. “Nothing in your records indicates a hereditary link for your cancer,” she told the patient, who was relieved that her children wouldn’t be at higher risk for cancer due to a genetic mutation.
“That’s the best part, helping people better understand their risks, and how they can combat the scary world of cancer,” said Keilman. “If they are identified, they can begin getting family members tested and screened, and hope to avoid the cancer for future generations.”