HBOC Genetic Counseling:
A Genetic Counselor-Physician Partnership Model
Joan Oliver, Amy Cronister
Integrated Genetics, Laboratory Corporation of America® Holdings, Genetic Counseling Services, Monrovia, CA
INTRODUCTION
 The American Society
of Clinical Oncology
(ASCO) has consistently
addressed the oncologist’s
role in integrating cancer
genetic risk assessment
and management into
clinical practice and has
supported pre-and posttesting counseling by a
qualified health professional
for patients at increased
risk of hereditary cancer
susceptibility.1
 In 2014, Integrated Genetics
began offering genetic
counseling in collaboration
with physicians whose
patients have a personal
or family history of breast
or ovarian cancer.
 The goal of this study was
to determine if a Telegenetic
Counseling program for
Hereditary Breast and
Ovarian Cancer (HBOC)
was operationally feasible
and to test its utility for
providers for whom cancer
genetic counseling may
not have been readily
accessible.
METHODS
All referrals made in 2014 to Integrated Genetics for genetic counseling
for a personal or family history of breast and/or ovarian cancer were
analyzed. Genetic counseling was provided by active candidate/board
certified Genetic Counselors who are licensed in the state of residence of
the patient, where required by law. Data was gathered from 247 counseling
sessions provided to patients from 23 states.
 Patients were referred for telegenetic counseling (TGC) by OB/GYN, Family
Practice, Internal Medicine, or Oncologist providers and called one of two
centralized appointment centers, depending on the patients’ time zone,
as appropriate under applicable laws.
Patients were scheduled and subsequently sent an invite to their TGC
session to be conducted via WebEx. WebEx was selected for its easy-touse software which allows for the use of PowerPoint type visual displays,
two-way webcam use, and HIPAA compliance.
lThe scheduling staff requested medical records, such as previous
molecular testing, and emailed the patient a cancer family history
questionnaire, to be completed prior to the appointment.
All patients were provided a comprehensive genetic counseling session
including a three generation pedigree, review of records and test results,
and discussion of principles of cancer genetics, benefits and limitations
of genetic testing, and implications of potential test results.
lGenetic risk assessment for HBOC was provided to all patients based
on family and personal history and where applicable, cancer risk
models such as BRCAPRO. Genetic testing options were discussed
based on National Comprehensive Cancer Network® (NCCN®)
testing criteria.2
lWhere available, NCCN screening and surveillance recommendations
were discussed, but patients were referred back to their provider
to discuss patient-specific management and treatment
recommendations.
All patients and referring providers received a written Genetic Counseling
Report summarizing the genetic counseling session.
Data on family and personal history of cancer, quantifiable genetic risk
assessment, whether NCCN criteria were met, and testing decisions were
entered in to the IG Genetic Counseling Information System.
A subset of patients was seen via in-person genetic counseling, and
received the same services as for TGC.
RESULTS
Figure 1. During 2014, 247 counseling sessions
were provided to patients from 23 states. All
patients had a personal or family history of
breast or ovarian cancer and the average
age of patients was 44 years (range: 16-85).
Gene�cCounselingDemographics
247
Totalpa�entscounseled
198
Pre-test
49
Gene�cCounselingDemographics
Post-test
247
23
Totalpa�entscounseled
Statesserved
198
Pre-test 44(16-85)
Averageage(range)
49
Post-test
23
Statesserved
Averageage(range) 44(16-85)
Figure
2. Sixty four percent (64%) of sessions
Gene�cCounselingSessions
were done via WebExWeb-Ex
and 36% In-person
in person.
GCModality
159
88
Gene�cCounselingSessions
%
64%
36%
Web-Ex In-person
GCModality
159
88
%
64%
36%
Figure 3. Of the 247 sessions, 198 (80.2%)
were for pre-test genetic counseling; of those,
173 (87.4%) met NCCN HBOC genetic testing
criteria and genetic testing for BRCA1/2
was offered.
Patients Seen for Pre-Test Counseling n=198
Figure 4. Of those offered testing, 70.52%
desired testing, 27.75% declined, and 1.73%
were undecided.
Patients Offered BRCA1/2 Testing n=173
48
28%
25
12.6%
173
87.4%
NCCN HBOC criteria not met
Met NCCN HBOC criteria
3
2%
122
71%
Accepted
Declined
Undecided
The remaining sessions (n=49) included post-test counseling for pathogenic mutations or variants of uncertain
significance (n=39), and patients who had accepted testing but whose results were pending (n=10).
CONCLUSION
REFERENCES
The Integrated Genetics HBOC genetic counseling program extended comprehensive genetic counseling to patients
at increased risk for BRCA1/2 mutations who might not otherwise have access to this service. According to the applicable
guidelines, physicians appropriately selected patients for referral (87% met NCCN testing criteria). The genetic counselors
provided cancer genetic risk assessment, time-intensive patient education to facilitate informed decision making,
and counseling about the implications of results, including the complexities of variants of uncertain significance. This
collaborative model ensured physicians retained full patient care oversight, including management of screening and
surveillance, while leveraging genetic counselor expertise.
1.Robson, ME, Bradbury, AR, Arun, B, et al., American Society
of Clinical Oncology policy statement update: Genetic and
genomic testing for cancer susceptibility. J.Clin Oncol 2015 Nov 1;
33(31):3660-7; doi:10.1200/JCO.2015.63.0996. Epub 2015 Aug 31.
2.Hereditary Breast and/or Ovarian Cancer Syndrome. NCCN
Guidelines Version 2.2015. Available at: http://www.nccn.
org/professionals/physician_gls/pdf/genetics_screening.pdf.
Accessed November 18, 2015.
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