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. ​​

This section provides information on how to access genetic testing, direction for HCP referrals, as well as resources for health professionals  discussing hereditary cancer risk assessment with their 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 "Mainstream" tab below.

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

Referral/Eligibility

The Hereditary Cancer Program provides assessment and/or genetic testing for people most likely to have a hereditary cancer risk. 

How to refer

To refer a patient, complete all sections of the 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 pathogenic variant in a hereditary cancer gene (refer for carrier testing)
  • A pathogenic variant in a hereditary cancer gene identified through private pay genetic testing or a research study (refer for review of clinical implications, clinical confirmation and/or carrier testing for family members)
  • A pathogenic variant in a hereditary cancer gene identified prior to moving to BC (refer with request for high-risk cancer screening)
It is most informative to start a hereditary cancer risk assessment in a person that has had a relevant diagnosis. If this is not possible, unaffected family members may still be referred for assessment. 

Answers to some common questions are provided below. You are also welcome to contact HCP staff by email with questions. 

Frequently asked questions

Below are answers to commonly asked questions about HCP referrals:

 
It is most informative to start a hereditary cancer risk assessment in a person that has had a relevant diagnosis. When that person’s short-term prognosis is poor, or their health is unstable, urgent storage of a blood sample is recommended.

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 has
  • 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 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 pathogenic variant in a hereditary cancer gene confirmed in a family member? 
  • Does the reported history meet current criteria to offer an appointment?
  • Do we need additional medical records? 
  • Do we need additional family history information?
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. Some patients are provided information about access testing via an online portal in this letter
  • 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 meets specific criteria. Genetic counselling may be an important part of a decision to have genetic testing.

Genetic testing looks for an inherited change (pathogenic variant) 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 change.

The first (index) test in a family is usually most informative if offered to someone who has had a relevant diagnosis. Storage of a blood sample is recommended for a person with uncertain health if they 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 pathogenic variant in a hereditary cancer gene is found, then a specific carrier test is available for family members. A carrier test can include a panel of hereditary cancer genes or look at only the specific gene in the family. 

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 pathogenic variant in a hereditary cancer gene 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. Patients may be offered the option to access testing via an online portal. 

 
Travel is NOT required. Most appointments are by telephone. Some patients are offered the option to access genetic testing via an online portal, where the blood draw can be done local to their area.

 
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.

HCP has a program to follow-up with pathogenic variant carriers over time. Pathogenic variant carriers are sent a survey about once a year by email (if known) as our way to check-in about their medical care and other information or support needs. If an individual indicates in the survey that they have questions, support needs, or has not had all recommended screening tests, an HCP team member will follow-up by phone. 

 

Yes, self-referrals to HCP are accepted. 

If there is a known pathogenic variant in a hereditary cancer gene in the family, it is helpful for the person referring to the HCP to have details about the variant available in advance (e.g. letter, report, family reference number).

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 about hereditary cancer topics​. 

Additional information


Risk Management

Individualized risk management recommendations are typically provided following hereditary cancer consultation. The documents listed below provide information abou the cancer risks and risk management guidelines for specific hereditary cancer genes. 


The High Risk Clinic provides ongoing risk management support for a subset of hereditary cancer pathogenic variant carriers. You can read more here.​ 

Additional information

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


Mainstream

A direct pathway to genetic testing is available to some patients. This is called "mainstreamed" hereditary cancer genetic testing. You can order the test directly and disclose the result to your patient. Patients with a positive result or a suspicious variant of unccertain significance will be reflexively referred to the HCP for genetic counselling and further assessment. 

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 t​o 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 genetic testing, as well as a checklist for ordering the test:

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

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