The Power of Knowing: Genetic Counseling and Cancer Prevention 

Kelley: 

Genetic counselors (GCs) are trained in both genetics and counseling. We help people understand how inherited conditions might affect them or their families. We also look at genetic test results and family history to help guide care. 

In cancer care, we look for signs that someone may have inherited a higher risk for cancer. If we think testing might help, we talk with patients about what the tests can show, what the risks and benefits are, and what results might mean.  

If a person has a genetic change (also called a genetic mutation) linked to cancer, we help them understand what types of cancer they are at risk for, how to screen for (look for) that cancer or what management is available, and what family members are at risk for having that same genetic change. 

It’s important to know: not all cancer is inherited. We don’t see every patient with cancer, only those whose personal or family history suggests a possible inherited risk. 

Kelley: 

To become a certified genetic counselor, you first need a master’s degree from a program approved by the Accreditation Council for Genetic Counseling. After that, you take a board exam from the American Board of Genetic Counseling. 

In New Hampshire and many other states, GCs also need a license. This means we can see patients on our own and that only trained professionals can call themselves genetic counselors. 

Amanda: 

Knowing your genetic risk helps you and your healthcare providers make better choices about your cancer care. If someone has a genetic change that raises their cancer risk, they might benefit from earlier or more frequent screenings, or even consider surgery or medicine to lower their risk. 

Results also could guide treatment for those who already have a diagnosis of cancer. Plus, genetic counseling gives family members a chance to learn about their own risks. Overall, it helps people take charge of their health and make informed decisions. 

Kelley: 

One big myth is that genetic testing tells you if you have cancer. It doesn’t. We’re looking at the DNA you were born with to see if you’re at higher risk, not checking for active cancer. 

Another myth is that genes “skip a generation.” That’s not true either. We all get half our genes from each parent. Just because someone doesn’t get cancer doesn’t mean they didn’t pass on a gene that increases risk. 

Also, some genetic risks affect certain organs or people differently. So even if one person with an increased genetic risk doesn’t ever develop cancer, their child might, depending on the gene and their body. 

Kelley: 

Right now, we don’t take self-referrals at Foundation Hematology & Oncology. That means patients need to be referred by a doctor. Most of our referrals come from oncologists, primary care providers, OB/GYNs, gastrointestinal doctors, and other specialists who notice a personal or family history that might suggest a higher cancer risk. 

Amanda: 

We start by reviewing the patient’s personal and family history of cancer. Then we talk about how inherited cancer risk works and go over testing options. We explain the benefits, limits, and what the results might mean. 

If the patient wants to move forward, we collect a blood sample and send it to a genetic testing lab. We also plan follow-up steps, like reviewing results and talking about screening, prevention, and how to share this information with family. 

Amanda: 

I make sure patients understand what the test can and can’t tell us. We talk about the types of results we might find, including unexpected ones, like risks for cancers they weren’t expecting. 

I also help them think through how they might feel about the results and what it could mean for their health. My goal is to make sure patients feel informed, supported, and ready to make the choice that’s best for them. 

Amanda: 

We go over the results together and explain what they mean in simple terms. Whether the result shows a known risk, something unclear, or no findings, we talk about next steps. 

This might include referrals to specialists, changes in screening plans, or ways to share the information with family. We also help patients figure out which relatives might benefit from testing and how to talk to them about it. 

Kelley: 

We look for certain signs that might suggest a hereditary cancer risk, like: 

• Certain cancers diagnosed under age 50 
• Three or more relatives (on the same side of the family) with the same or related cancers 
• Two or more different cancers in the same person 
• Rare cancers like ovarian, pancreatic, male breast cancer, or high-risk prostate cancer 

Kelley: 

We see adults aged 18 and older. That way, patients can make their own choices and give consent for testing. In rare cases, we may see a child but only if we already know they’re at risk for a specific hereditary cancer syndrome. 

Amanda: 

It’s completely normal to feel anxious or overwhelmed during these sessions. We talk about complex topics that can affect both the patient and their family. I try to be patient and kind, and I listen closely. I let emotions guide the pace of our talk. 

I also break down the science into simple parts and make sure patients know that testing is always their choice. My hope is that people feel heard, supported, and confident in whatever decision they make. 

Kelley: 

Working with cancer patients and their families is incredibly meaningful. Many have been through a lot, whether they’re in treatment, caring for someone, or worried about their own risk. 

Genetic testing can give them answers and help guide their care. It’s powerful to see how motivated people are to learn more and protect their health and their loved ones. Being part of that journey is truly inspiring.