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FH Gene Sequencing and Deletion/Duplication

Test code(s) 38805


 Question 1. What is the clinical application of this test?

This test is used to identify individuals with autosomal dominant hereditary leiomyomatosis and renal cell cancer (HLRCC). It detects single-nucleotide variants, deletions, and duplications in the FH gene, which codes for the enzyme fumarate hydratase. Sample reports and information regarding the specific variants analyzed for each gene are available on our website QuestHereditaryCancer.com.


 Question 2. The gene mutation in this individual’s family is known. What other test might be appropriate?

If a familial mutation has been detected by sequencing or deletion/duplication studies, the Hereditary Cancer Single Site(s) test (test code 93945) may be considered. Official test results of the family member must be available for laboratory review. For more information, please visit our website QuestHereditaryCancer.com. To discuss a family history with a Quest Diagnostics genetic counselor, please call Quest Genomics Client Services at 1.866.GENE.INFO (1.866.436.3463).


 Question 3. What are the clinical indications for this testing?

Generally, this test may be indicated for individuals with

    Multiple cutaneous leiomyomas

    Symptomatic and/or multiple uterine leiomyomas before age 40

    Renal cell carcinoma before age 40

    A close relative who meets one of the above criteria1

Informed consent following genetic counseling is strongly recommended before testing. Whenever possible, consider testing the person in the family with the youngest at the time of diagnosis related to HLRCC.


 Question 4. Whom can I ask for help regarding a specific case?

For more information or to discuss a family history with a Quest genetic counselor, please call
Quest Genomics Client Services at 1.866.GENE.INFO (1.866.436.3463).


 Question 5. When is the right time to pursue this test?

The right time is different for every individual. An individual’s current medical status, personal experience with symptoms of HLRCC, treatment or screening plan, and general readiness for genetic information all influence the decision to be tested. Having an open dialogue with individuals about these topics can assist with shared decision-making.


 Question 6. How do I know if insurance will cover this testing?

Upon receipt of a fully completed order, our team will verify coverage with your patient’s healthcare insurance plan and estimate their likely out-of-pocket responsibility. If your patient’s estimated responsibility is over $100, we will notify you and/or your patient prior to test initiation to discuss options for continuation or cancellation of the test. Please note that orders lacking complete information will not be processed.


 Question 7. How quickly can I expect results?

On average, results will be completed 14 to 21 days after receipt of the sample in the laboratory if the family history form and order are complete and the health plan does not require preauthorization. Turnaround time may vary based on delays caused by incomplete orders or insurance authorizations.


 Question 8. What does a positive result mean?

Individuals with a positive result have a pathogenic or likely pathogenic variant detected in the FH gene and a diagnosis of HLRCC. A positive result does not mean that an individual has a diagnosis of cancer. Specific risk information will be provided in the result report, and you can visit our website at QuestHereditaryCancer.com for more information.


 Question 9. What does a negative result mean?

A negative result means that a pathogenic or likely pathogenic variant was not detected in the FH gene. For more information regarding specific genetic variants analyzed in this assay, please refer to the methods and limitations section of the genetic testing report. Implications of this result depend on the situation:

Individual with previously diagnosed cancer or tumor: An individual’s risk of recurrence or a related new cancer or tumor is based on their personal and family histories. In some instances, it may be appropriate to test for other hereditary forms of cancer or tumors. Please call Quest Genomics Client Services at 1.866.GENE.INFO (1.866.436.3463) to discuss possible additional studies with a genetic counselor.

Individual without previously diagnosed cancer or tumor, but with a family history of cancer or tumors: An individual’s risk of tumors or cancer is based on their personal and family histories. Testing an affected family member may further inform this risk assessment. In some instances, it may be appropriate to test for other hereditary forms of cancer. Please call Quest Genomics Client Services at 1.866.GENE.INFO (1.866.436.3463) to discuss possible additional studies with a genetic counselor.


 Question 10. What does a variant of uncertain clinical significance (VUS) result mean?

A VUS result means that the variant has not been previously described in the literature or that the clinical significance is unclear based upon currently available evidence. Medical management decisions should be based on personal and family history. Family studies may help to learn more about the clinical significance of this variant. The classification and interpretation of the variant(s) identified reflect the current state of Quest’s understanding at the time of the report. Variant classification and interpretation are subject to professional judgment and may change for a variety of reasons including, but not limited to, updates in classification guidelines and availability of additional scientific and clinical information. It is important to check in with the laboratory annually for variant updates because new information regarding the variant and classification may become available over time. Please visit QuestDiagnostics.com/VariantIQ for information about variant classification. If you have questions, please call Quest Genomics Client Services at 1.866.GENE.INFO (1.866.436.3463) to speak with a genetic counselor.

 

Reference

    Menko FH, Maher ER, Schmidt LS, et al. Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment. Fam Cancer. 2014;13(4):637-644. doi:10.1007/s10689-014-9735-2


This FAQ is provided for informational purposes only and is not intended as medical advice. A clinician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

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Version 0: Effective 08/30/2021 to present