Article authored and provided by Myriad as part of a paid partnership with NSGC. The content, views, and opinions expressed in this article are those of Myriad, and do not necessarily reflect the opinions and views of the National Society of Genetic Counselors

This past November 10^th marked the sixth annual Genetic Counselor (GC) Awareness Day. The first GC Awareness Day in 2017  served as a day for GCs to share what inspired them to join the field, along with advice for prospective students. In more recent years, this annual event has turned into an opportunity to spread awareness of our field and profession to other health professionals, patients, and aspiring GCs, while also expressing our appreciation of our colleagues.

On this GC Awareness Day, I found myself reflecting on the remarkable evolution of the GC field and profession. In 2014, I was job searching in a market that felt empty, despite the significant (75%) workforce growth since 2006¹. The job board at the NSGC Annual Conference in 2013 was bare (yes, there was a physical job board with paper and thumbtacks), but I was fortunate enough to secure a part time role at a start-up clinical genetic counseling company. The role started as in-person counseling housed in a state-of-the-art fertility center, but quickly evolved into a hybrid of both in-person and telegenetics due to the needs of my patients. At that time, only 25% of GCs involved in direct patient care telecommuted, compared to 71% in 2022^2,3.

Genetic Counselors have proven to be the masters of evolution (and I’m not just talking about their education). We have shifted how we see our patients along with out-of-the-box thinking to accommodate the growing number of patients who require genetic counseling. As the landscape of genetic testing changed, I watched the demand for genetic counseling skyrocket. Thinking back to my summer rotation in cancer genetics, the “Angelina Jolie effect” had our phones ringing off the hook. Since then, cancer genetic testing has become more accessible, affordable, and sought after by patients.

The expansion of hereditary testing criteria also allowed for more patients to be identified as appropriate candidates to receive testing. Ten years ago, societal guidelines recommended genetic testing if a patient was diagnosed with breast cancer at 45 or younger⁴. Since then, the criteria have expanded to include any person diagnosed with breast cancer if the tumor has certain pathological features or if they plan to pursue treatment such as PARP inhibitor therapy⁵. Other groups also began to publish consensus guidelines and statements, such as the American Society of Breast Surgeons (ASBrS), who suggested “genetic testing should be made available to all patients with a personal history of breast cancer”⁶. As genetic testing criteria evolved and expanded significantly, the demand for genetic counseling appointments continued at a rate faster than we could get clinical GCs into the field!

According to the American Cancer Society, in 2023 over 297,000 individuals assigned female at birth will be diagnosed with breast cancer ^7. So how will we begin to accommodate these patients? Luckily, we are good at evolving! Conversations about genetic counseling extenders and alternative service delivery models began early on and were even addressed in a joint statement made by the ASBrS and the NSGC in 2021. In this joint statement, both groups acknowledged that “breast surgeons with sufficient experience and appropriate training in hereditary risk assessment/genetic testing should be able to order genetic testing when indicated”⁸. The traditional model of a 40 to 60-minute pre-test genetic counseling session with genetic counselors solely ordering testing has evolved to models that include point of care testing, phone, video and/or AI genetics education along with partnerships with genetic counseling extenders. This evolution in practice has been presented at various conferences and published throughout the literature. Excitingly, alternative delivery models have proven to reduce the number of clinic visits, increase the completion of genetic testing and do not cause statistically significant differences in anxiety, depression or decisional regret^9,10.

Many labs have partnered with genetic counselors and healthcare professionals to provide telegenetics education to patients within their clinical visit or from the comfort of their own home. At this year’s NSGC Annual Conference, during the Myriad Sponsored Lunch Symposia Panel, Sara Rhode MS, CGC from the Cleveland Clinic Florida, described how she integrated patient education to streamline her own practice. This resulted in an additional 150-200 new patients per month, which if using a traditional model would only allow for an average of 40 new patients to be seen³. Sarah explained how she had integrated the Myriad patient education team into her practice, and therefore was able to accommodate 100 new patients per month, along with STAT patients. As I looked around the room, I could see the other GCs’ wheels turning. We CAN have it all. We can accommodate the increase in patient volumes without burning ourselves out or re-inventing the wheel. In the words of Charles Darwin “it is not the most intelligent that survives. It is the one that is most adaptable to change”.

For more information about the patient education team at Myriad please visit https://myriad.com/genetic-counselors/

References

1. National Society of Genetic Counselors. (2014) 2014 Professional Status Survey. https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey
2. National Society of Genetic Counselors. (2016) 2016 Professional Status Survey. https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey
3. National Society of Genetic Counselors. (2023) 2023 Professional Status Survey. https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey
4. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Hereditary Breast and/or Ovarian Cancer Syndrome Version 1.2012. 2023 June 2; National Comprehensive Cancer Network. Available
5. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic. Version 2.2024. 2023 September 27; National Comprehensive Cancer Network. Available from: https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf
6. Manahan et al. Consensus Guidelines on Genetic Testing for Hereditary Breast Cancer from the American Society of Breast Surgeons. Ann Surg Oncol. 2019 Oct;26(10):3025-3031.
7. American Cancer Society. Cancer Facts & Figures (2023). Atlanta: American Cancer Society. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2023-cancer-facts-figures.html
8. The National Society of Genetic Counselors. (2021) NSGC Position Statement: ASBrS-NSGC Joint Statement of Medical Societies Regarding Genetic Testing Requirements. https://www.nsgc.org/POLICY/Position-Statements/Position-Statements/Post/asbrs-nsgc-joint-statement-of-medical-societies-regarding-genetic-testing-requirements-1
9. Chai et al. Mainstreamed genetic testing of breast cancer patients: experience from a single surgeon's practice in a large US Academic Center. Fam Cancer. 2023 Oct;22(4):467-474.
10. Swisher et al. Remotely Delivered Cancer Genetic Testing in the Making Genetic Testing Accessible (MAGENTA) Trial: A Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1547–1555.

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