Same-day genetic counselling for breast cancer patients

worried couple with counsellor

Delivering a cancer diagnosis is one of the most difficult parts of the job for Dr. Nancy Down, Medical Director of the Breast Integrated Care Collaborative and Division Head of General Surgery at North York General Hospital (NYGH). When she does, her newly diagnosed patients are surrounded by compassionate and caring health care professionals at the BMO Financial Group Breast Diagnostic Clinic (BDC). The team provides all of the support patients need during a cancer diagnosis and throughout their treatment. Among the many services offered to patients is genetic counselling if there is an indication the cancer could be caused by genetic factors.

For the past year, the BDC has been providing same-day genetic counselling appointments for newly diagnosed patients, first as part of a pilot and now as a routine practice. In most centres, patients who are referred for genetic counselling book a separate appointment for a later date.

Patients get information sooner

The pilot started when NYGH Genetic Counsellor Ingrid Ambus saw an opportunity to provide more timely care for patients with “on-the-spot” genetic counselling so they could learn about their genetic risk factors sooner and avoid a separate trip to the hospital for a counselling appointment. 

“Before we implemented this new program, we really gave a lot of thought to whether or not offering genetic counselling on the same day as receiving a breast cancer diagnosis would be overwhelming for patients,” says Ingrid. “Knowing the benefits of same-day counselling and that patients typically want as much information as possible as soon as it is available, we felt this service would improve the care we offer to patients during their cancer journey.”

Approximately 5% to10% of breast cancers are due to hereditary factors. In 2013, actress Angelina Jolie helped raise global awareness about hereditary breast cancer when she shared that she had undergone a preventative double mastectomy after learning she carried a mutation in one of the breast cancer genes, which put her at a higher risk of developing breast and ovarian cancer.

Testing can help inform treatment decisions

Most inherited cases of breast cancer are associated with mutations in two genes: BRCA1 and BRCA2. If a person is diagnosed with breast cancer and is found to have a mutation in either of these two genes, it means they are at a higher risk of a new cancer happening in the future. Genetic testing helps inform patients and their doctors about treatment decisions around taking additional steps to reduce the chance of a new cancer happening in the future.

Genetic counsellors are trained in medical genetics and counselling to interpret genetic test results and to speak with patients about:

  • How inherited diseases and conditions might affect them or their families
  • How family and medical histories may impact the chance of disease occurrence or recurrence
  • Which genetic tests may or may not be right for them, and what those tests may or may not tell

(Source: National Society of Genetics Counselors)

“If patients opt for same-day genetic counselling, they will meet with one of the NYGH cancer genetic counsellors to review their family history and learn more about the genetic tests available to them,” says Ingrid. “Patients can then have their blood work done and we expedite the results since they can really help with treatment decisions.”

The Molecular Genetics Laboratory at NYGH is one of only a few hospitals in Ontario to perform hereditary cancer genetic testing. In fact, other genetics clinics in the GTA and across the province send their blood samples to the NYGH molecular lab to be tested. 

Ingrid Ambus
Genetic Counsellor Ingrid Ambus

If genetic testing shows that a patient does carry a cancer causing gene mutation, they may consider taking steps to reduce their future cancer risk by having a mastectomy. With this choice also comes the option of having oncoplastic surgery at NYGH, which involves both removing the breast and reconstructive surgery during the same operation. 

“Knowing that I can make one phone call and patients can meet with a genetic counsellor and receive the necessary testing during their first appointment is evidence of the high-quality care we provide at North York General,” says Dr. Down. “Our team, the care environment and our state-of-the-art equipment all come together to create a unique atmosphere where breast cancer patients can feel safe, supported and confident they are receiving the best possible care.”

NYGH has the only comprehensive breast cancer care program in Canada to receive full accreditation from the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. For more information on breast cancer care, please visit the NYGH website

This article first appeared in the April 2019 issue of The Pulse. 

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