Presymptomatic DNA testing has introduced a new category of
patients—those who do not have cancer but are at increased risk.
They have been through the process of making a
decision about DNA testing. When at risk, they may opt for surveillance,
preventive
surgery, or other ways to reduce their risk. Their
frame of reference may be well known, as in BRCA; it may be less familiar, as in Lynch syndrome; or it may be obscure, as in HLRCC.
A looming challenge for the field is to provide adequate guidance based on evidence,
resources, and, most importantly, the preferences of the patient.
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