Improving Referral Pathways for High-Risk Patients

In an interview with Targeted Oncology^TM, Ranjit Goudar, MD, of Virginia Oncology Associates, discusses why improving hereditary cancer care requires looking beyond genetic testing to strengthen cancer risk assessment, screening, and referral pathways across the continuum of care.

According to Goudar, one of the greatest opportunities lies upstream—helping referring providers identify patients at elevated cancer risk before a cancer diagnosis is made. He notes that many physicians were trained to refer patients to oncologists only after a tissue diagnosis, but advances in hereditary cancer assessment and risk-based screening have expanded the role of community oncology in caring for healthy individuals who may benefit from prevention strategies and enhanced surveillance.

Goudar highlights several patient populations that often go unrecognized despite having elevated cancer risk, such as individuals with numerous precancerous colon polyps who test negative for known hereditary mutations yet still require intensive surveillance, along with their close relatives, who may also benefit from earlier and more frequent colonoscopy screening. He also reviews the growing importance of breast density as a risk factor, emphasizing that updated screening recommendations for women with extremely dense breast tissue underscore the need for greater patient education and appropriate referral for supplemental imaging.

Rather than focusing solely on genetic test results, Goudar advocates for a comprehensive, longitudinal approach to hereditary cancer risk assessment. Because family history, screening recommendations, and genetic knowledge continue to evolve, community oncology practices should develop systems to identify high-risk individuals, educate patients and families, coordinate referrals, and provide ongoing reassessment. He says that this broader approach will be essential to improving early detection, cancer prevention, and long-term outcomes for patients and their relatives.