Genetic counseling isn't just for young people worried about their future—it's a tool that can reshape how entire families understand and manage cancer risk, regardless of age. When Nancy Love was diagnosed with breast cancer at 86, her doctors at MUSC Hollings Cancer Center didn't dismiss her case as simply bad luck. Instead, they recognized a pattern woven through three generations of her family and referred her to genetic counseling, a decision that would ultimately help her daughter and granddaughter take control of their own health. What Happens During Genetic Counseling? Genetic counseling begins not with a test, but with conversation. During sessions lasting 20 to 40 minutes, certified genetic counselors map out detailed family histories and walk patients through their cancer risk and what it means for them and their relatives. According to Libby Malphrus, a certified genetic counselor with over 20 years of experience, the role is not to push testing but to empower people to make informed decisions. "We talk through the likelihood that this is hereditary, the pros and cons of testing and what someone would do with that information," Malphrus explained. "Our role as genetic counselors is not to push testing. It's to empower people to make the best decision for them." The science behind genetic testing has advanced dramatically—when Malphrus started counseling 25 years ago, doctors tested one or two genes. Today, panels analyze 70 or more genes at once. How a Single Test Can Ripple Through Three Generations Love's genetic testing revealed she carries a pathogenic mutation in the BRCA1 gene, one of the most well-known genes linked to hereditary breast and ovarian cancer. BRCA genes normally help repair DNA and protect cells from becoming cancerous. A harmful BRCA1 mutation weakens that protection, significantly increasing lifetime breast and ovarian cancer risk. It can also raise the risk of prostate, pancreatic and other cancers in men and women. The critical insight: carrying the mutation does not guarantee someone will develop cancer, but it does change screening and prevention strategies. Because Love tested positive, her children were offered genetic testing at no cost. Her daughter, Katherine Sherwen, age 63, had hesitated for years—watching relatives face cancer while worrying about insurance implications. But when her mother's results came back positive, she decided she needed clarity, not just for herself but for her daughter. Katherine's positive test result reframed her entire care plan. Rather than standard annual mammograms, she now receives enhanced breast cancer screening that includes alternating mammograms and breast MRIs every six months. Preventive surgery, such as a prophylactic mastectomy, may also be considered. "It shifts you from reactive to proactive," Malphrus said. "Instead of waiting, you're actively managing risk". Steps to Take If You Have a Family History of Cancer - Document Your Family Tree: Write down which relatives have had cancer, at what age they were diagnosed, and what type of cancer. Multiple people on the same side of your family with the same or similar cancers is a red flag worth discussing with your doctor. - Talk to Your Doctor About Genetic Counseling: You don't need to wait for a cancer diagnosis. Consider genetic testing if you or a close relative was diagnosed with cancer at a young age (before age 50), or if multiple family members have had cancer. - Understand Your Options Before Testing: Genetic counselors help you weigh the pros and cons of testing, including potential insurance implications. There is no right or wrong timeline—some people are ready to test immediately, while others need time to think through the implications. - Share Results With Relatives: If you test positive for a hereditary cancer gene, your siblings and children may be at risk. Many genetic counseling programs offer free testing to relatives of people who carry mutations. Why Age Shouldn't Be a Barrier to Answers One of the most striking aspects of Love's story is that she was 86 when referred for genetic counseling—an age when many doctors might have dismissed the value of testing. But Malphrus challenged that assumption. "Earlier in my career, people would have thought it was crazy to refer an 86-year-old woman for genetic counseling," she said. "But this isn't just about the individual patient. It's about impact: what a result could mean for children and grandchildren". Love's case underscores why surveillance matters, particularly for those at elevated risk. While most cancers occur by chance, about 5 to 10 percent are hereditary, caused by inherited gene mutations passed down through families. "It's about catching cancer at its earliest stages or even preventing it altogether," Malphrus said. The Bigger Picture: How Cancer Death Rates Are Falling Love's story unfolds against a backdrop of remarkable progress in cancer prevention and treatment. Cancer death rates in the UK have fallen to a historic low, with rates dropping 29 percent from the peak in 1989 to about 247 deaths per 100,000 people today. In the past decade alone, the death rate has fallen 11 percent. Several cancers have seen particularly dramatic declines. Ovarian cancer death rates dropped 19 percent between 2012-2014 and 2022-2024, stomach cancer fell 34 percent, and lung cancer dropped 22 percent. Breast cancer death rates fell 14 percent, cervical cancer 11 percent, and leukaemia 9 percent. Much of this progress stems from prevention and screening programs. Cervical cancer death rates have fallen 75 percent since the 1970s, largely because of the NHS cervical screening programme. The human papillomavirus (HPV) vaccine, introduced in 2008, is also driving down cervical cancers—at least 6.5 million people in the UK have received the vaccine since its introduction. For Love's family, genetic counseling transformed something abstract—family history, risk, uncertainty—into something concrete. All three women met with Malphrus in one room, mapping out their entire family tree. "We've always talked about cancer in our family, but seeing it visually was eye-opening," said Margaux Sherwen, Love's granddaughter, who at 22 now stands at a crossroads. She has a 50 percent chance of carrying the BRCA1 mutation but has chosen not to pursue testing yet. "It's a very personal decision," she said. "If insurance weren't a factor, I'd probably do it tomorrow. I think more information is always better. But there are implications you have to think through". Even without testing, Margaux has taken a crucial first step: awareness. She is establishing healthcare in her new home and making sure her doctors know about her family history. For a family shaped by unanswered questions, genetic counseling turned uncertainty into understanding and clarity into confidence about the future.
