What Credentials Should You Look When Selecting A Genetic Counselor?
Genetic counselors specialize in many different fields including (but not limited to): prenatal counseling, pediatrics and cancer.
In the United States and Canada, a Certified Genetic Counselor (CGC©) must obtain a Master’s degree in Genetic Counseling from an Accreditation Counsel for Genetic Counseling (ACGC) Accredited Program. Once all requirements have been met, an individual may apply and sit for the Certification Examination. The American Board of Genetics Counselors (ABGC) is the organization that certifies genetic counselors in the United States and Canada.
Why Should One Consider Meeting With a Genetic Counselor?
If one has a personal and/or family history of cancer (on mother and/or father’s side of the family) it is worth considering meeting with a genetic counselor. In fact, the National Comprehensive Cancer Network (NCCN) guidelines recommend that all women with ovarian cancer have a genetic risk assessment. Your genetic counselor will take a detailed medical and family history. He/She will draw a detailed family tree, also known as a pedigree, and will be able to help guide your decisions about genetic testing. The genetic counselor will also answer questions about insurance coverage, genetic discrimination (the Genetic Information and Non-Discrimination Act protects against this), risks to family members, and future cancer screening and prevention options. Genetic counselors will be able to interpret any uncertain genetic testing results. Furthermore, they can determine whether one is still at increased risk for cancer/other cancers even in the event of a negative test result.
How Do I Find A Genetic Counselor?
The National Society of Genetic Counselors (NSGC) has a Find A Counselor Section on its website, or you can ask your local physician to direct you to a local board eligible or board certified genetic counselor.
How Is A Genetic Test Performed and What Genetic Tests Will My Genetic Counselor Order for Me?
A genetic test is performed by testing DNA obtained from a blood or a saliva sample. The specific genetic test/s that your genetic counselor will recommend will be determined by your personal and/or family history of cancer. The known high-risk genes involved in familial ovarian cancer and/or endometrial cancer include BRCA1, BRCA2, MLH1, MSH2, MSH6 and PMS2. There are other genes that have been associated with moderately increased risks for ovarian and endometrial cancer. Your genetic counselor will be able to determine if testing for these other genes is appropriate.
Is There Anything That I Can Do To Prepare for My Meeting With My Genetic Counselor?
The more information you provide to your genetic counselor about your medical history and/or family history, the better they will be able to provide you with an accurate genetic risk assessment. Examples of important information to provide include:
- If relevant, your specific cancer diagnosis, age of diagnosis and the pathology of your cancer diagnosis (what your cells looked like under the microscope).
- Details on who in your family has been diagnosed with cancer. Specifically, the age and specific type of cancer diagnosis. When possible, it is ideal to provide pathology reports on your relatives’ cancers to confirm these diagnoses. This may require a little work on your part to obtain this information, but it can greatly aid the genetic counselor’s risk assessment.
- Details (i.e. pathology reports) of any colon polyps you or your family may have had removed in the past.
- Details of any skin lesions you or your family might have had removed (for example, sebaceous adenomas, multiple basal cell carcinomas or melanomas).
What Does Pathology Have To Do With My Risk Assessment?
We have learned that certain types of cancers are associated with different inherited syndromes. For example, the high-grade serous ovarian cancer sub-type has been associated with BRCA1/2 mutations. Alternatively, the endometrioid/clear cell endometrial cancer subtype/s are more likely associated with Lynch Syndrome compared to the serous endometrial sub-type.
Prenatal testing for BRCA1/2 or other known cancer gene mutations is technically possible. However, prenatal testing for germline mutations that predispose to adult-onset cancers which have some treatment available and do not affect intellect are uncommon. Preimplantation Genetic Diagnosis (PGD) may be an option to families if there is a known familial cancer gene mutation. This is a technology that uses an IVF procedure to test the cell of an eight-cell embryo, with the goal of implanting embryos without the known gene mutation back into the mother. For further information, speak to your genetic counselor.
American College of Obstetricians and Gynecologists
Force: Facing Our Risk of Cancer Empowered
National Society of Genetic Counselors