Dr Mark Kris Explains Changes Emerging From Genetic Testing

The use of genetic testing has led to a radical change within certain specialties and hospital departments. And although doctors are being asked to do more, they do it gladly because the work leads to better treatment decisions for patients, said Mark G. Kris, MD, William and Joy Ruane chair in thoracic oncology at Memorial Sloan Kettering Cancer Center.

Transcript (slightly modified for readability)

What are hospitals and health systems doing to incorporate personalized medicine and the use of the human genome into care delivery?

Today most of these tests are tissue based so they're under the guidance and supervision of the department of pathology. And it's really led to a radical change with pathology departments dealing with cancers.

Whereas everything before was focused on a pathologist making an expert judgement based on looking at piece of tissue under a microscope, pathology departments now have to get these genetic tests done, get them done very quickly with near 100% accuracy, and factor that into the decision-making process as to what kind of cancer you're going to say this person has and the characteristics of it. It's asked the pathology department to turn themselves on their head. It had been all about looking at tissues under a microscope and being very precise there. Now, in addition to that, which we still use and need, they have to develop all this technology to get this done.

And other specialties have been affected too. It used to be that lung cancer would be diagnosed on maybe just a few cells—a lung specialist would brush a tumor and a few cells would be sent to the pathologist to make a diagnosis or they would put a tiny needle into the tumor and make a diagnosis. Now you need more tissue because it needs to be sufficient for the genetic analysis that is so critical for making decisions. So doctors that do biopsies, doctors that analyze biopsies are being asked to do a lot more, but I think they gladly do it because they know it leads to better decisions for patients.

In lung cancer there is so much concern and fear when the diagnosis is made. People discover "my lung cancer spread to my bone, it spread to my brain," and when we find one of these genetic changes, people become so fearful about what's going to happen to them, and I tell them "We found this genetic change, I want you to take these tablets and come back and see me in 1 or 2 months." And the patient is kind of shaking their head: "Wait a minute, I have lung cancer, it's spread to my brain, it's spread to my bone, I've heard a lot of very scary things and suddenly you're handing me this prescription and telling me to come back in 2 months?"

But that is how things can happen now. It's how potent these changes are for the cancer cell and how potent the drugs are we have to help people with those changes.