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To outwit cancer, they give up stomachs

A hereditary ill forces some to remove organ

LOS ANGELES -- Mike Slabaugh doesn't have a stomach. Neither do 10 cousins.

Growing up, they watched helplessly as a rare hereditary stomach cancer killed their grandmother and some of their parents, aunts, and uncles.

Determined to outsmart the cancer, they turned to genetic testing. Upon learning they had inherited a flawed gene of their grandmother, Golda Bradfield, they had two options:

Risk the odds that they might not develop cancer; the chance that they would was put at 70 percent.

Have their stomachs removed. The latter would mean a life of eating very little, very often.

All the cousins chose the operation. Doctors say they are the largest family to have preventive surgery to protect themselves from hereditary stomach cancer.

``We're not only surviving, we're thriving," Slabaugh said, 16 months after his operation at Stanford University Medical Center in Palo Alto.

Advances in genetic testing are giving families with bad genes a chance to see the future, sometimes with the hope of pre emptive action.

People have had stomachs, breasts, ovaries, colons or thyroid glands removed when genetic tests showed that they carried a defective gene that gave them a high risk of cancer.

But what about people whose families don't have these defects? Researchers say that someday, doctors may do DNA tests as routinely as they check cholesterol levels now, and thus spot risks that can be lowered. That day has not arrived yet, but progress is being made.

By 2010, there might be several such tests, along with recommendations to help high-risk people avoid certain diseases, said Dr. Francis Collins, head of the National Human Genome Research Institute. Newborns are routinely tested now for some genetic conditions, but those tests generally focus on substances in the blood rather than on DNA.

To come up with a useful DNA mass-screening test, it is not enough to identify a particular gene variant that raises the risk of a disease, specialists said.

There are other questions:

Are there enough potential cases in the general population to make mass screening worthwhile?

Is there evidence that screening would improve health?

Is the risk of disease is high enough to make the test result useful?

``Mass screening with DNA testing isn't quite ready for prime time," said Dr. Ned Calonge, head of the US Preventive Services Task Force.

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