Q&A: Genetic Counseling
A UTSW expert offers answers to frequently asked questions.
Cancer is caused by changes, or mutations, to genes (pieces of DNA in our cells that tell the cells how to make the proteins the body needs). Sometimes those mutations are inherited from our parents and are embedded in genes from the time we’re born. Other times, alterations to the genes occur during our lifetime – the result of exposure to cancer-causing substances, for example.
Hereditary or germline genetic testing looks for certain mutations in genes that can run in families. But deciding whether to undergo testing – and knowing what to do with the results – is complex. Sara Pirzadeh-Miller, M.S., CGC, Assistant Director for Cancer Genetics at UT Southwestern Medical Center, shares how genetic counseling can help.
Q. What is the role of a certified genetic counselor?
Ms. Pirzadeh-Miller: Certified genetic counselors, or CGCs, are mid-level providers with specialized master’s-level training in genetics as well as psychology. Our job is to fully comprehend the role of genetics with its application to patient health care and to make it easy to grasp for our patients. Certified genetic counselors ensure patients have an understanding of how genetics could impact their health care, as well as health risks for relatives.
Q. How can I make sure I’m seeing someone who is properly trained?
Ms. Pirzadeh-Miller: Be sure to look for the credentials “CGC” (certified genetic counselor) after a genetic counselor’s name to verify the person is board-certified. Genetic counselors who have recently graduated from an accredited training program are board-eligible and can consult with patients while they prepare for the board exam to become a CGC. In Texas, there is currently no additional licensure.
"Anyone can consider genetic counseling and testing, and the certified genetic counselor will walk you through understanding testing logistics and insurance coverage issues specific to your situation."
Q. How do I know whether I should see a CGC?Ms. Pirzadeh-Miller: Anyone can consider genetic counseling and testing, and the CGC will walk you through understanding testing logistics and insurance coverage issues specific to your situation. But there are “red flags” for hereditary cancer risk that people should know. Someone who’s been diagnosed with cancer at a particularly young age (examples: breast cancer diagnosed at or under age 45, colorectal cancer at or under age 50) or with a rare cancer (examples: all ovarian and pancreatic cancer diagnoses) might be referred to a CGC because there is a question that it might be an inherited cancer. Inherited genetic mutations are involved in about 5 to 10 percent of all cancers, with higher percentages of some types of cancer. Having insight into what this really means for you is invaluable. In addition, people who are unaffected by cancer but have a family history of the disease might also benefit from genetic risk assessment and testing. In the end, we welcome anyone who has concern about their personal and/or family history of cancer even if they don’t fit a particular criterion. It is important to know genetic testing costs have dropped dramatically over the past several years, putting these tests within reach for more people.
Q. Should I see a genetic counselor before or after genetic testing?
Ms. Pirzadeh-Miller: It could be either one. At Simmons Comprehensive Cancer Center, the majority of our patients have not had genetic testing yet and come to us for a pre-test risk assessment where they gain an understanding of the benefits and risks of genetic testing before deciding if it’s right for them.
That said, we’re certainly seeing an increasing number of people who have already done genetic testing elsewhere and are coming to gain a better understanding of their results or to determine if they need additional and/or confirmatory testing.
The Benefit of Genetic Counseling
Genetic counseling ensures you understand the benefits and risks of testing so you are fully aware of what it could mean for you and your family before making the decision to move forward with testing. And once you have the results, you have someone who can explain what the findings could mean for your cancer risk and how to make a cancer risk reduction plan. For these reasons, certified genetic counselors are becoming an ever more critical resource in this era of personalized medicine.