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Hereditary Cancer

The Hereditary Cancer Program (HCP) provides genetic counselling and genetic testing for BC/Yukon residents who may have inherited an increased risk for certain types of cancer. Similar services are available across Canada and in other countries.

This section provides direction about HCP referrals, information and resources for health professionals to use when discussing hereditary cancer assessment with your patients/families.

Some patients with a personal history of cancer are eligible for "mainstreamed" hereditary cancer testing. You can order the testing and disclose results to your patient without a referral. You can find more information in the "Resources" tab below.

Have a patient in the High Risk Clinic? Learn about your role in their care.

Referral
People are encouraged to review their personal and/or family history with a health care provider to clarify whether HCP referral is indicated. 

How to refer

To refer a patient, print the current HCP Referral form, complete all sections and send it by fax.

HCP referrals are accepted for BC/Yukon residents with: 

  • Personal history that suggests inherited cancer risk 
  • Family history that suggests inherited cancer risk 
  • A close relative who has a confirmed hereditary cancer gene mutation (refer for carrier testing)
  • A hereditary cancer gene mutation identified through private pay genetic testing or a research study (refer for review of clinical implications and carrier testing for family members)
  • A hereditary cancer gene mutation identified prior to moving to BC (refer with request for high-risk cancer screening)
Answers to some common questions are provided below. You are also welcome to contact HCP staff by email with questions about whether to make a referral. 

Frequently asked questions

Below are answers to commonly asked questions about HCP referrals:

 
The most informative approach to genetic testing is usually to offer the first test in a family to someone who has had a relevant cancer diagnosis. When that person’s short-term prognosis is poor, or their health is unstable, urgent storage of a blood sample may be prudent.

The goal of storing a blood sample is to allow for the possibility of hereditary cancer genetic testing in a family. No testing is done on a stored blood sample until the appropriate family member has had genetic counselling and completed an informed consent process. An adult family member who is aware of that blood sample is welcome to follow-up at an appropriate time in the future.  

Please print and use the Urgent DNA Storage Requisition  provided for this purpose. Contact HCP staff with any related questions. Call 604-877-6000 local 672198 (Vancouver office), 604-851-4710 local 645174 (Abbotsford office), or send an email.

 
Referrals that include a request for urgent assessment are reviewed promptly by HCP staff. Please provide a specific timeline and reason for expedited assessment (i.e. details about unstable/poor health or how genetic test results will impact specific immediate medical management decisions).

The referring physician will be contacted if additional information is required to support the request, or to explain why we are unable to provide an expedited appointment.

 
  • If your referral includes a request for expedited assessment, please include a clear statement of the reason and the requested timeline; our ability to follow-up will be delayed if we have to clarify those details
  • Relevant pathology reports, related operative reports and consult letters must be provided with a request for assessment unless those documents are already included in the patient’s BC Cancer chart
  • Carrier testing referrals: include a legible copy of any family member documents (genetic test report, family info letter, etc.) that your patient received
  • For someone who is not a current BC Cancer patient, the referral form must include current and complete contact information (mailing address, email and phone numbers)
  • If a family member needs to be the 1st contact, please provide that person’s name and phone number(s)
  • Please do not send a copy of the entire chart

 
HCP triage staff review each referral to confirm details such as:

  • Is expedited assessment requested to inform immediate decisions about cancer/other medical treatment?
  • Is a specific hereditary cancer gene mutation confirmed in a family member? 
  • Does the personal history of cancer/other features fit current criteria to offer an appointment?
  • Do we need to review additional medical records? 
  • Do we also need to review the family history of cancer?
Depending on the information above, the next steps may include: 

  • Requesting additional information from referring provider and/or patient
  • Booking an appointment
  • A letter to the patient confirming they are on a waiting list 
  • A letter to inform the referring provider and patient that no appointment will be booked
The referring provider will receive a written summary of the cancer risk assessment and risk management recommendations when HCP consultation is complete.

 
Genetic testing is offered when the patient’s personal and/or family history of cancer meets specific criteria. Genetic counselling is an important part of a decision to have genetic testing.

Genetic testing looks for an inherited change (mutation) in a gene that is known to increase the risk for specific types of cancer. It is usually done on a blood or saliva sample. Only about 5-10% of all cancers are linked to an inherited gene mutation.

The first (index) test in a family is usually most informative if offered to someone who has had cancer. Storage of a blood sample may be prudent for a person with uncertain health if s/he might be the best index for genetic testing in a family. For more information on the storage of blood samples, expand the "Urgent storage of a blood sample - when, why and how?" section above.

Most index genetic testing is currently done using a panel of hereditary cancer genes.  Information will be provided on which genes are being tested and the possible results.

If a hereditary cancer gene mutation is found, then a specific carrier test is available for family members. A carrier test can look at only the specific gene in the family or also include a panel of hereditary cancer genes. 

Hereditary cancer genetic testing is usually offered to people aged 19 years or older. It may also be available to children and adolescents if the results will change their medical care and/or after genetic counselling. 

 
We provide expedited appointments if: 

  • A gene mutation has already been identified in the family
  • Genetic test results are needed to help with immediate clinical management decisions 
  • Requested for a patient who is eligible for consultation and is in poor health
For regular referrals, patients receive a letter to confirm they are on a waiting list.

 
Travel is NOT required. Most appointments are by telephone.

 
Follow-up is available for a patient who had an HCP genetic counselling appointment, or was not offered an appointment when previously referred. 

Reasons to request HCP follow-up include: 

  • New cancer diagnosis in patient or family member
  • New genetic test results in a family member
  • Questions about new options for genetic testing or review of previous genetic test results
  • Questions about cancer screening and risk-reduction
  • Questions about available supports and resources
Complete a new HCP Referral form or contact HCP staff directly to request follow-up. Call 604-877-6000 local 672198 (Vancouver office), 604-851-4710 local 645236 (Abbotsford office), or send an email.

 

Self-referrals to HCP are accepted if a relative has shared details (e.g. letter, report, family reference number) about their hereditary cancer gene mutation.


Self-referral may also be an option for a patient who does not currently have a family doctor or nurse practitioner. 

Patients are welcome to contact HCP to discuss self-referral.


Call 604-877-6000 local 672198 (Vancouver office), 604-851-4710 local 645236 (Abbotsford office), or send an email.

 
The HCP team includes specialized physicians, genetic counsellors, nurses and support staff. Working together, we provide hereditary cancer risk assessment, genetic counselling and genetic testing. Our team also provides education (link to other section) about hereditary cancer topics. 

Additional information


Syndromes


Hereditary Cancer Syndromes

Please note the information below is under review and will be updated in late 2023.

The fact sheets below provide information, referral criteria, cancer risks and cancer risk management guidelines for the following hereditary cancer syndromes:

Additional information

The following websites are excellent resources for those seeking more information about specific hereditary cancer syndromes:


Resources
HCP provides and recommends resources for those who seek additional information and support related to hereditary cancer. 

Mainstreamed Genetic Testing

Some patients with a personal history of cancer are eligible for "mainstreamed" hereditary cancer testing. This means you can order the testing and disclose the result to your patient. You can find the current eligibility criteria for mainstreamed genetic testing and the requisition for the test on the Cancer Genetics and Genomics Laboratory website.

If you are considering offering mainstreamed genetic testing to one of your patients, please review these slides.

We also have a video and information sheet that you can share with your patients about hereditary cancer testing, as well as a checklist for ordering the testing:

If you have any questions about mainstreamed hereditary cancer testing, please contact us at genetic.counsellor@bccancer.bc.ca.

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SOURCE: Hereditary Cancer ( )
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