CANCER GENETIC COUNSELING. PART I - WESTERN EUROPEAN COUNTRIES
CANCER GENETIC COUNSELING. PART I-WESTERN EUROPEAN COUNTRIES (Abstract): Genetic counseling services represent a relatively new concept aimed to identify patients or relatives with hereditary predisposition for cancer susceptibility and to act accordingly for early diagnosis, cure and prevention. It has become an accepted part of oncology care in many European countries. Unfortunately, despite the same state of knowledge, the patients from different European countries would experience different care. This situation is not in accordance with the European Union directives, which are enacted to implement and protect the idea of free movement of goods, services, people and capital. This study aimed to examining the current practice of genetic counseling for cancer in different European countries, with special accent on familial breast and ovarian cancer management as the most studied and managed hereditary cancer. We also sought to ascertain the needs for the unitary politics in cancer genetics services, to decrease the difference in cancer genetic counseling opportunity and facility. As a first step we compared the national guidelines regarding genetic counseling for familial/hereditary breast and ovarian cancer in some countries from Western Europe. All guidelines recommend embedding genetic testing within a framework of genetic counseling, and all agree to perform genetic testing first in an affected person. However, we found some differences regarding the thresholds, detailed description of selection criteria, the risk calculation methods, the age of diagnosis, the relationship with counselor and physician etc. There are also many open questions that are not covered by the guidelines, for instance: how to deal with phenocopies, unclassified variants, and newly identified breast cancer susceptibility genes or with family that not fitting the criteria, that need to be discussed. New evidence is usually slowly integrated into the guidelines. An exchange process towards the harmonization of the guidelines will ensure high quality health care across Europe.
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