Genetic counselling for familial breast and ovarian cancer in Ontario

Advances in molecular medicine and increasing attention of the media to clinical developments in genetics have spurred the demand for genetic counselling services for several conditions, most notably for hereditary cancers.1,2 Genetic counsellors in the Canadian province of Ontario serve a population of 11.7 million, of whom approximately 85% live in urban areas and 15% live in rural areas.3 The costs of most genetic counselling and related health activities in Ontario are covered by the provincial health plan (OHIP). In almost all cases, block funding is provided by the Ontario Ministry of Health to support genetic counselling services in the hospital setting. There are no private genetic services offered and there is no patient co-payment. Currently, special funds are allocated for cancer genetics services, in addition to funds provided for other genetics services, although an individual genetic counsellor may provide services in both domains. We conducted a descriptive survey of genetic counselling activities in 27 centres in Ontario, Canada to determine the relative distribution of genetic consultations by medical condition, under the current health care system. For the purposes of this study, a genetic counsellor was considered to be a health care provider, practising in a hospital setting, whose primary role was to provide genetic assessment and counselling. A provisional list of all Ontario genetic counsellors was compiled by searching the 2001 membership directories of the Canadian Association of Genetic Counsellors (CAGC, 2001) and of the American National Society of Genetic Counselors (NSGC, 2001). In addition, we telephoned all clinics on the CAGC list of Canadian Genetics Clinics and clinic administrators were asked to provide the names of all people providing genetic counselling in their centre. In addition, a “snowball” technique was used to ascertain genetic counsellors not identified …