High-risk clinic is available to help

Published 12:05 am Tuesday, June 25, 2024

Having a family history of cancer, surviving multiple cancers herself and being diagnosed with Lynch Syndrome through genetic counseling, Mary Willis Page of Salisbury said she would get anxious when those anniversary dates of her cancer rolled around and spent lots of time doing research. 

She told her doctor she needed someone who knew all the research out there. She needed a point guard, and it was Dr. Matt McDonald, her GYN ocologist, who directed her to the Novant Health high-risk cancer clinic where she met Adult Nurse Practitioner Amy Bush, who, as Page said, “has become my point guard.”

Now, in addition to her team of doctors who help her stay on top of her health and regular screenings, Page pays an annual visit to see Bush who takes the lead on a number of additional things.

She knows Page’s history, her concerns and they’ve developed a good patient/provider relationship.

These include reviewing her medical, surgical and family history, looking at and implementing guidelines, which she said come from the National Comprehensive Cancer Network.

Bush will do patient exams and inform them of the latest research, “so I don’t have to worry about this. If she feels any tests are needed, these can be ordered as well, and these could be fancy ones that her general practitioner doesn’t have,” Page said. “So I get a more thorough overview.”

During her visits at the clinic, Page said they also review whatever may be happening and see if anything has changed, along with reviewing colonoscopies and endoscopies and making sure she has done all of her screenings for the year. If there are concerns, those are addressed and Bush has the patient follow up with their doctor.

And if there are family members who might need to consider genetic testing, she can provide guidance where they need to go.

The genetic center, Page said, gave her a letter to share with her family explaining about the gene mutation, and also letting them know it “does not mean you are doomed to cancer. It just means you are at higher risk, which is knowledge,” which she said is power.

Page expressed how great Bush is and that “she listens to me. I don’t feel like oh, I’ve got 15 minutes.” She said all of her providers treat her this way, and they make her feel special and cared for.

Bush shared that the high-risk clinic is in Charlotte and she still goes to that clinic several times a month. However, she sees Page, who is an established patient, in Mooresville where Bush primarily works.

The clinic was started in 2013, and “that’s when we were just checking for a few different gene mutations,” Bush said. She started there in 2015.

It is a small clinic, she said, with a staff of five genetic counselors, two surgical oncologists, Lori Gentile, who is the breast surgeon and medical director, one medical oncologist and two nurse practitioners.

As for what takes place at the Novant Health high risk clinic, she said, they see patients who are at an increased risk for developing cancer and for most of those, that is based on family history.

“If the family history is compelling enough, we send them to our genetic counselors who are also within our clinic. They’re the genetics clinic, and we’re the risk clinic to see if maybe they have a gene mutation,” she said. 

At the clinic, Bush said they look to guidelines to put into practice their screening and surveillance for patients to “reduce their risk for developing a future cancer or to detect a cancer early so that we can prevent a long treatment or any treatment at all.”

Additional responsibilities they help the patients with include setting up for a colonoscopy or if they need other screenings, they will get those. 

“We make sure that all those ducks are in a row to ensure that they’re receiving the proper screening or surveillance based on their risk,” Bush said.

Many of their patients come from referrals from primary care doctors and gynecologists, but she said they also receive them from genetic counselors and people can also self-refer. They can be reached by calling 980-302-6270.

When considering if one is a candidate for genetic counseling, Bush shared a list of characteristics to think about including if the person has a personal or family history of breast, uterine or colon cancer diagnosed under age 50; if diagnosed with more than one cancer; when thinking about hereditary cancers, considering ovarian, pancreatic, male breast or metastatic prostate cancer; an individual with more than 10 colon polyps; someone with an Ashkenazi Jewish heritage, who are at higher risk; a gene mutation associated with an increased cancer risk; and multiple people on the same side of the family with cancer.

While Bush said getting genetic testing is a personal decision, there are things to think about including insurance, in particular life and disability insurances, which can be affected by it. She also noted the many screenings and surveillance if found to have a gene mutation, which most want to have because they want to reduce the risks and they want to share that information with family members.

It’s great to have a team,” said Page, “and it’s great to have knowledge.”

In addition to Bush, other members of the team include her GYN oncologist McDonald; her dermatologist Dr. Aaron Wever who she said has lots of knowledge about Lynch Syndrome; her gastroenterologist Dr. Kiran Jagarlamudi; and her primary care physician Dr. Christopher Goodman.

“It’s just a team effort when you have a genetic mutation like I do and want to live a long life,” said Page.

And while cancer is still a part of her life, she said it doesn’t define her. She is a survivor and warrior and is reminded to focus on the things that are really important.

“And I still do that,” she said. “Cancer and being high-risk reminds me to let the little things go, to prioritize what’s important to me, to make time, to do things now, travel where I want to go, to not wait, to make that phone call, to write that card, because you may not have tomorrow.”

In sharing about the clinic, Bush said, “it’s important that people know we are there. For those that think they are at a higher risk, we are out there and we can help.”