An Introduction to Genetic Counseling With Hiam Abdel-Salam, MS, CGC, and Catherine Skefos, MA, MS, CGC

In this first episode of Oncology Data Advisor’s new podcast series, “Bridging the Gap in Cancer Care Through Genetic Counseling,” Hiam Abdel-Salam and Catherine Skefos provide an introduction to genetic counseling, including how they entered the field, what they do on a day-to-day basis, scenarios in which patients should or should not consider meeting with a genetic counselor, things that are covered in an appointment, and their favorite parts about working as genetic counselors.  

Oncology Data Advisor: Hi everybody, and welcome to this latest episode of Oncology Data Advisor. Today, I have the honor of being joined by two of our new Editorial Board members, Hiam Abdel-Salam and Catherine Skefos, who are both Genetic Counselors at MD Anderson Cancer Center. We’re so excited to, first of all, have you on the board, and also to have this conversation today. You’re going to be giving us a little bit of an overview of what you do Genetic Counselors and telling us a little bit about yourselves. With that, I will turn it over to both of you, and you can introduce yourselves and take it away.

Catherine Skefos, MA, MS, CGC: All right, thank you so much. We’re excited to be here. Like you said, we’re going provide an overview of hereditary cancer, genetic counseling, and cancer risk evaluation today. I wanted to start by talking a little bit about how we got to the field of genetic counseling. Hiam, would you mind starting us off with telling us about how you became a genetic counselor?

Hiam Abdel-Salam: MS, CGC: Yes, so the truncated version is I really enjoyed my high school genetics class, especially the parts where we learned about how genetic diseases are a family thing. It impacts different family members instead of just your patient. When I started college, I was kind of the typical pre-med. I knew I wanted to interact with patients in some way, but it got to a point where I knew I wasn’t particularly interested in being a physician but was still really interested in clinical genetics. I did some research and was lucky enough to get connected with genetic counselors at my university, and I was able to intern with them. That gave me the chance to learn a lot more about hereditary cancer conditions and what cancer genetic counseling is, and that set up the path for me to end up in genetic counseling school. What about you, Catherine? I’m really curious about how you started.

Ms. Skefos: My story is very different—and we’ve worked together for years now, and I never heard that story, so I’m glad we’re talking about it. I had not heard too much about genetic counseling in high school or anything like that. I did enjoy my genetics class in college, but I found it really difficult. I actually even had a professor tell me that maybe genetics wasn’t for me, which is sort of funny in hindsight. I ended up studying medical anthropology after college. I got a degree in that and then I worked in nonprofit for a while and worked with cancer patients in more of a fundraising type of avenue. But I didn’t find myself quite fulfilled enough, because I wanted to get back to the science aspect of things. I realized how much I loved working with cancer patients and that I wanted to do it in more of a clinical setting. I was able to go back to school for genetic counseling, and that’s how I ended up here. And turns out that professor was not right—genetics is my thing.

Ms. Abdel-Salam: I think that’s my favorite part of our field—that everybody has such different journeys for how they ended up in genetic counseling, and every path is just as valuable.

Ms. Skefos: Absolutely. So, let’s talk about ending up in genetic counseling on the other side of the table or the other side of the room. Who is recommended to be seen by a genetic counselor in the cancer realm?

Ms. Abdel-Salam: I usually tell people that anybody who has an interest in learning about hereditary contributors of cancer—whether it’s their own or if they don’t have cancer themselves but have family members who do—I always say that genetic counseling is a good fit for them to have the conversation. I think there can sometimes be a misconception that you have to know that you are interested in genetic testing to want to see a genetic counselor, and that’s certainly not the case. It really is about providing information and learning more about your interest in testing or not. I would say that within the general population of people who have a personal family history, there certainly are individuals that we’re a little bit more suspicious for, who have more red flags than others. The ones that I always think about in the back of my mind as I’m talking about patients are those early cancer diagnoses, especially with the more common cancers like breast, colon, or uterine cancers.

I’m sure, Catherine, because you’re a lot more in the rare malignancies and rare benign tumor space, there can certainly be specific types of tumors or cancers regardless of age where we tend to be more suspicious. Those might be certain types of brain cancers, pheochromocytomas, paragangliomas, those kinds of patients. We always like to encourage to be seen by a genetic counselor to talk about options for genetic testing. Overall, if providers are talking to me and say their patient mentioned genetic testing questions or questions about their family history, I say, “Go ahead and send them to us,” whether or not they meet the guidelines. Definitely, the early onset cancers, the rare kinds of cancers, or even if they’re seeing similar cancers in a family that’s clustering on the same side or certain patterns that might make us suspicious for a specific condition, then those are really great patients to come and see us.

Going along with that, Catherine, I’m sure that genetic testing is getting more and more accessible throughout the years. What do you think makes seeing a genetic counselor specifically unique and helpful for a patient instead of just getting testing ordered by their doctor or going online and ordering testing for themselves? Do you think that interaction is really valuable?

Ms. Skefos: Yes, we might be a little bit biased, but we definitely see value in that interaction. Part of the definition of genetic counseling is the process of helping people understand and adapt to genetic risk of disease. I think that’s a really big part of what we do. Many of us in our training programs—all of us, really—are trained both in the counseling side of things and the science side of things. It really makes us uniquely able to connect with patients and help them understand abstract concepts like risk and how that risk might impact them—not only physically with their chances of developing a cancer or tumor, but also emotionally in the possible anxiety that can come from knowing this type of thing, navigating discussions with family members, and delivering difficult news to family members or their children or whoever it might be that might also have that increased risk.

I think that genetic counselors can really bridge that gap between the psychological and the physical in terms of helping people understand what their risks might be. Then the other part of things is we can often take more time than some other providers with a patient. We’re fortunate in many cases to have 45 minutes or an hour to spend with a patient if they need it to discuss not only their family history and the logistical things about genetic testing, but also what I was mentioning before about those psychosocial impacts and things like that. I always think, just like Hiam said, if someone is even interested in thinking about their hereditary risk, a genetic counselor is a great first stop to help them understand their options and what it might mean for them.

Hiam, we’ve talked a little bit about the process of genetic counseling, but how can people actually use the results of genetic testing for their benefit or their family’s benefit?

Ms. Abdel-Salam: There are so many different ways and I think each way is different depending on that particular patient or family. Definitely the most common one is providing information on either the primary contributor to a cancer diagnosis or one of the many contributors to a cancer in a family. Really thinking about information and what’s causing these cancers in a family can often provide patients with some solace and peace, helping them understand, “Okay, this is why I developed this cancer” or “This is why there are so many of these similar cancers in my family,” which maybe they didn’t understand before doing the test.

Beyond that, in many cases, genetic testing can be helpful in making decisions for treatment. Among the many different centers I work with, the two that involve that the most are the breast and the prostate centers. I see a lot of patients, particularly in the prostate clinic, that are coming in with metastatic disease and wanting to know if they would qualify for medications like olaparib. That qualification is defined by generative testing results if they have a BRCA1 or BRCA2 mutation. That’s definitely one way that genetic testing can have a significant impact on survival, really making sure that we’re taking care of our patients and giving them the best treatment that is available for them.

Outside of treatment, we also think about other primary cancers that patients may be at risk for. Just knowing if you’re at risk for a primary cancer in general can really help patients make decisions about management. That can go as far as surveillance recommendations, including earlier or more frequent surveillance. Sometimes we might be thinking about prophylactic surgery—prophylactic mastectomies or prostatectomies to significantly reduce the risk of developing a primary cancer.

Then as we’ve been talking about so far in this conversation, we’re also thinking about our patients in a family unit. How does this information impact cancer risks for other people in your family—your children, siblings, parents, even extended relatives? This is information that might be helpful for them to know if they’re at a significantly elevated risk for certain types of cancers, really giving them a head start to make sure they’re following the appropriate cancer screening. This is usually something that I think is really great for patients to get a general picture ahead of time when helping them to make a decision on whether this test is a good fit for them.

Ms. Skefos: Absolutely. I always like to walk patients through those different potential outcomes of testing. Sometimes, one more than the other resonates with a patient about what might prompt them to do the testing.

Ms. Abdel-Salam: Definitely. A lot of times I’ll hear that patients were coming in maybe not so much for themselves, but wanting to know for their family members if this is something that’s going to be helpful. Going over that with them is really something that tips the scale on whether this could be informative for them.

Catherine, we talked a little bit about what is entailed in genetic counseling and some of the topics that we might think about for those people that we’d want to come into the session. Can you tell me a little bit about when you’re either in that in-person interaction, on that video call, or on that telephone call, and some of those topics that you really like to make sure you’re covering with the patient?

Ms. Skefos: I always like to start my appointments with patients by asking them in some way what their understanding is of the purpose of the appointment. Especially if a patient has an active cancer diagnosis, they are just having appointments added to their schedule left and right. I always want to make sure going into the appointment that they know what my job is, what we’re going to talk about during the appointment, and what they hope to get out of the appointment if they do have any specific questions when coming in. From there, we always go through a detailed medical history and family history. We take really detailed family histories, not only about the people who have had cancer, but those who haven’t had cancer as well. We really want to get the full picture so that we can make an accurate risk assessment.

Then from there, I always do my genes and chromosomes blurb. I don’t care if this person across from me is a geneticist or a physician. They might know more about certain topics in genetics than I do, but I always want to make sure that everybody’s on the same page and understanding what we’re talking about. I talk about how we all are born with over 20,000 genes, and an important set of those genes is meant to protect us from developing cancer. That’s really what we’re looking at. We’re looking at the genetic information that a person was born with to see if they were born with a difference in one of those genes that caused them to have a higher risk of developing cancer. Sometimes my genes and chromosomes spiel is as simple as that, and sometimes I go into a little bit more detail depending on the exact indication that we’re talking about.

From there, we talk about genetic testing options in terms of whether we want to do a very specific genetic test or whether we want to do a broader test. When I say “we,” I really mean the patient. It’s up to them how broad they want to go with genetic testing, although there’s typically a minimum recommended testing or guidelines the patient met that we can guide them with. We don’t just say, “Okay, what type of testing do you want?” We say, “Here are some options. Here’s the testing that’s indicated based on your personal and family history, and here are some other options as well.”

We then talk about the logistics of testing. We can do it through a blood sample or a saliva sample for children. We can do testing through a cheek swab as well. That can be easier for a parent to get a sample that way from a child. Then if someone has a blood malignancy or has had a stem cell transplant, we talk about needing to do testing through a skin punch biopsy. Once we have the sample, which for a vast majority of people is either blood or saliva, the results take about two or three weeks from that time to get those results back, at which time we would let them know the results say and what that means for them and their family. The appointment is sort of a quarter information gathering, a quarter information giving, and then some back and forth discussion about what type of testing feels best for the patient and whether now is even the right time for them to do testing. If they’ve just been diagnosed, maybe it’s not the right time. We are able to talk with the patient at length about what feels best for them in terms of testing,

Ms. Abdel-Salam: I love how we talk about it as a conversation instead of, “Okay, this is the test that we are recommending that you take,” which is rarely how we frame it.

Ms. Skefos: Exactly. I can think of really just a handful of indications where we can say, “Okay, this is the cancer that we’re dealing with and here’s the one gene that we would test for.” That used to be how it always went, but now we know so much more about genetics. I like for our patients to understand that to some extent and see what type of testing feels best for them. So, when we get those results back in two to three weeks or so, can you talk a little bit about the different types of results and what that might mean for a patient?

Ms. Abdel-Salam: Definitely. There can be some rare instances, but in the general sense, we kind of talked about finding a hereditary cancer condition. That’s going to be our positive result. Basically, how I explain that to a patient is that of those 20,000 genes we have, there’s a subset that’s really supposed to be protecting us from developing specific kinds of cancers, but we might be born with one of those genes just not working properly or one copy of those genes not working properly. That’s because there’s a variant or a mutation that’s pathogenic and is impacting the ability for this gene to work well. In that conversation, if we find that there’s a result like that, we’ll talk about what specifically is that gene, what do we know from the literature and from our understanding of these genes, and the cancer risks that are associated with it. Then really the part the patient is invested in is the recommendation for screening. How does this change things for them and for other people in their family? That’s kind of the menu of things that we’ll talk about with positive findings.

With negative results, these are the most common results that we’re going to get back. In the majority of cases, we’re sequencing genes that everyone is born with, or those patients are born with them working perfectly fine. That’s the most common conversation that I’ll have with a patient. What I like to really emphasize with negative results, especially if we’re talking about a patient who does not know anything about a hereditary cause for cancer in their family—they’re coming in, they did genetic counseling, they did a panel—is that negative results are really reassuring. It definitely rules out many of the known hereditary causes for those cancers, but it doesn’t necessarily mean that this cancer or this family history is not hereditary. There’s always that residual risk that remains.

I just like to make sure to go over that and talk to patients about that remaining risk and limitations in genetic testing itself and the technology not being able to identify all possible mutations that someone can have. Then there’s also just our limited knowledge in candidate genes, those genes that may be related to specific cancers in a family, but we can’t test for them because the research just isn’t there yet in identifying the link of that gene with that specific cancer and knowing if we need to be making any changes in a patient’s care based off of that specific gene. We can definitely talk about this later on, but that’s kind of where thinking about options for updated testing can definitely come in for patients as we’re learning more and more about these genes.

Then something else that a lot of times patients don’t come in anticipating, or perhaps non-genetics providers are not too familiar with, are what we call those variants of uncertain significance. This means detecting a difference in a gene, but either there is limited clinical data or limited functional data on these specific variants, or there may be conflicting data around these variants where the lab is not able to truly say that this is pathogenic and is impacting the function of this gene and creating a cancer risk for patients and their families; or if this is something that’s likely benign, it’s just a normal variant that someone has in their gene not creating any cancer risks or any other health issues.

When we see these variants of uncertain significance, we typically act on the more conservative side, where we’re not recommending any changes with screening or management or changes in treatments, and we’re typically not recommending testing for people in the family for this specific variant. That’s because in about 90% of cases with these variants of uncertain significance, they end up being reclassified as benign or likely benign. That’s just because of the nature of genetics. We have several variants throughout our genetic code. It’s very common for us to have differences, and the majority of them are benign. Only a very small subset create some specific disease or health issue for a person or their family.

So, those are usually the different kinds of results that I like to go over. Now, there can be those quirky, funny ones like our mosaic findings, that I’m sure, Catherine, you’ve come across once in a while. Those are things where we might want to take on a little bit more preparation and go into a little bit more detail with the patient when those results come through about what that actually means for them and their family members.

So, Catherine, it’s pretty common, at least for me, to have a patient where they don’t really have a lot of understanding or even expectations for the session. They’ve either never heard of genetic counseling before, or it may be an appointment or a consult that their provider referred them for, but they did not really get a lot of context on what this appointment is going to be about or what they need to be bringing into a session. Do you feel like there’s anything that patients could do to be more prepared for coming into a genetic counseling session? Any information that would be great for them to bring in ahead of time?

Ms. Skefos: Yes, I think the main thing that people can do to prepare for a genetic counseling appointment is just to ask their family members about medical history. That’s the main thing. You don’t need to study up on your genetics or review your notes from college. Just ask your family about their cancer history, cancer type, age at diagnosis, perhaps even what type of treatments they had. Those can all be useful things that your genetic counselor might ask you about. Then two, if any family members have had genetic testing, get a copy of the results if possible. This is especially important if someone is seeing a genetic counselor or having genetic testing done because there is a known mutation in the family. It’s very important that the genetic counselor or whoever is ordering the testing can set their eyes on that report to be able to not only counsel accurately, to make sure that what we’re counseling on is what was found in your family, but also just to be able to order the correct test. We would never want to order the wrong test because we weren’t sure of what that genetic mutation was in the family.

Those are the main things that someone can do to prepare. Then Hiam, you had mentioned before that sometimes people might want to consider updated testing. In what circumstances do you think someone who has had genetic testing in the past might want to consider thinking about updated genetic testing?

Ms. Abdel-Salam: The most common instances are when patients have had prior genetic testing, but it was 10 to 15 years prior when our knowledge on the genes that are related to specific cancer types in a family, as far as hereditary conditions, were much more limited. A really common case I see is when a patient has had BRCA1 or BRCA2 gene analysis only. That was the extent of their tests because that’s all we knew about at the time. But now we know that there are several other genes that can predispose people to breast or ovarian cancer. That’s a really good example where we would encourage someone to come back in for genetic counseling to talk about going for updated genetic testing.

I usually just tell people it’s great to follow up with genetics every couple of years or so just to see if there are any new genes. We learn about new genes pretty frequently depending on the cancer type and the family history. I usually tell people that if they’re ever wondering about updated testing and they’ve already had negative results, it’s always still there for them to come back in and have that conversation again. I would definitely say that if you’re someone who’s already had testing, but it was many, many years ago, that’s a great opportunity to come back in and have that conversation with us. It really can be something that impacts screening explanations for both you and your family, and it also potentially impacts treatment depending on where you are with your cancer journey.

Ms. Skefos: I would also add to that if there have been any major changes in the family history, because perhaps when you first had testing done, it was because there was breast cancer on your mom’s side, but now a relative on your father’s side has been diagnosed with colon cancer. Something like that might prompt additional or different testing from what was originally ordered.

Ms. Abdel-Salam: I think that’s definitely a great example of how family histories can change very frequently. You may be coming in with limited information about your family, and now a couple of years later, you’ve learned new things. That can always be very valuable information to be evaluated for. It’s always great to either share that with your provider that you’re seeing annually or just kind of sending a quick message or giving a quick call to your general counselor to go over that information together.

Catherine, we talked a lot about the many great things that you can learn from a genetic counseling and genetic testing. What are some things that you think are helpful for patients to keep in mind where it may not be so beneficial for them to do genetic testing at this time?

Ms. Skefos: There are a few different reasons why people might not want to have genetic testing. Sometimes I’ll be talking with a patient, and I’ll say, “Is this testing that you think you’re interested in or that you want to do?” And they’ll say, “Absolutely, why not? Why wouldn’t everybody just go out and do this?” There really are a couple of good reasons that people might want to consider as they’re thinking about this.

One is that if someone is dealing with a new diagnosis and this genetic testing may not have a direct impact on the next step in their treatment, they may just decide that this is not something they have the capacity for right now. They may say, “Let me figure out what’s next. Let me figure out my surgery date.Let me get to feeling better after my surgery, and then I’ll consider opening up this aspect of my care and thinking about communicating with family.” One reason might just be timing. I regularly talk with people and say, “Okay, I’ll put you back on my calendar for three months from now and we can talk about this then when you might have a little bit more bandwidth to think about this side of things.”

The other thing that people might consider is genetic discrimination, which oftentimes people don’t even realize is a thing until we bring it up as part of the consent process for testing. There is a federal law called the Genetic Information Nondiscrimination Act. This protects people from discrimination when it comes to health insurance and most employment. Your health insurance company is not allowed to increase your rates or drop you from coverage based on a positive genetic test result. That’s a good thing. It’s reassuring that we have that type of protection, but that law does not extend to things like life insurance, long-term care insurance, and disability insurance. For those types of insurance policies, if you go to apply for a private policy for one of those types of insurances, they are allowed to ask for genetic testing results just like they’re allowed to ask for medical records or family history.

Oftentimes, especially when I’m meeting with a patient for predictive testing where maybe there is a known mutation in the family or there’s a family history of cancer, but the patient has not been affected at this time, that potential for genetic discrimination can come into play for some patients. They may opt to delay testing or not to have testing done if they do have concerns about insurance, but we always recommend that people discuss that with an insurance lawyer or something like that if they do have major concerns from that perspective, because even though we know about the law and we can educate to some extent, we are not lawyers. We can’t give out that type of advice, but we can at least let people know that it can be on their radar when they’re thinking about it.

Then sometimes people decline testing just because they don’t want to know, and that’s okay. Sometimes people just say, “I’m going to keep on doing the cancer screenings that my doctor recommends, but beyond that, I don’t want to think about future cancer risk at this time.” They may know themselves to know that it would make them too anxious or that it would be something that would constantly be on their mind, preventing them from living their best lives because they’d be worried about that. That’s also something that comes up sometimes and may make people not want to get genetic testing done.

Now, I know another possible reason people might have for not getting genetic testing can be cost. Hiam, how do you counsel patients about the potential for out-of-pocket cost for genetic testing? I feel like sometimes people have in their mind that this is going to cost them thousands and thousands of dollars.

Ms. Abdel-Salam: This is my favorite topic when speaking with patients, I usually will let patients know that in most cases, genetic testing is covered by insurance. That doesn’t necessarily mean that there’s not an out-of-pocket cost, but usually a majority of the cost is covered, especially if you are a patient who meets National Cancer Center Network (NCCN) guidelines for genetic testing. Guidelines exist for many different cancer types, including breast, ovarian, colon, pancreatic, and uterine cancers. Most private labs that genetic counselors will order testing through will estimate around $100 or less in the majority of cases where they have an in-network insurance with that patient’s provider.

Now, there definitely things that we can do if you’re outside of NCCN guidelines, or even if you are within guidelines but just want that reassurance to try to provide patients with more information. That could be things like trying to submit a prior authorization with your insurance company, or we can provide patients with billing codes, and they can inquire with their insurance company if this is something that’s going to be covered for them before they ever start the process of actually getting the testing done. Many private labs have what’s called self-pay prices for testing, where instead of going through insurance, you can have a direct bill that’s usually about $250 if you’re just wanting to pay independently. There are also patient assistance programs that exist with some of these labs, where if you provide some information on your financial situation, that can sometimes be enough to help reduce the price of your testing if for some reason it gets declined from your insurance.

Compared to the beginning of genetic testing where it was in the thousands of dollars, the landscape has definitely changed, especially now that insurance companies have specific criteria for how they cover genetic testing, which has helped to reduce the price. The changes in how testing is done have also significantly helped to reduce the price of testing. But it’s definitely an important conversation that I have with almost all of my patients, just to make sure, as much as I can control, that they’re not hit with anything unexpected.

As we get closer to wrapping up, Catherine, we definitely know that we rely on providers to make sure that they’re sending patients to us for genetic counseling, but sometimes providers don’t know that much about what genetic counseling is or how to refer their patients. There are also many patients out there that have never heard of genetic counseling. Are there any resources are kind of your go-to to share with a provider or a patient for them to learn a little bit more about counseling on their own?

Ms. Skefos: Definitely. Our national organization is called NSGC, the National Society of Genetic Counselors. There are a ton of resources on that website about what to expect in an appointment and who should see a genetic counselor. We’ve only been talking about cancer genetic counseling today, but there is also genetic counseling available for pregnant patients or patients who have pediatric conditions and things like that. The NSGC website is a great source of information about genetics and genetic counseling in general.

They also have a great tool that is very aptly named “Find a Genetic Counselor.” That is a great place where you can go to type in essentially anything you’re looking for—the location, the specialty, whether they offer telemedicine visits—and you can find genetic counselors in your area that might be able to help you. Then I also wanted to note that many genetic testing labs also have genetic counselors on staff. If someone has gotten a genetic testing report from their provider and they have additional questions, you can usually call the genetic testing lab directly and speak with a genetics provider in that way as well.

As we’re wrapping up this discussion, I just wanted to ask you, what is your favorite thing about being a genetic counselor and the job that you do?

Ms. Abdel-Salam: So many things. Of the many, I think my favorite is that I’m able to help patients understand things in simple terms and give them information to the level that they need to understand. I think especially for our patients who are going through active treatment for cancer, the field of cancer itself is filled with a lot of technical terms, a lot of scientific terms, a lot of different treatments, just a lot of information. Sometimes that can be overwhelming, and patients can oftentimes feel like they don’t really have a strong grasp of what’s going on.

One of my favorite things about my training is that we’re taught to communicate to patients at their level and in their communication style, providing them with just the right information that they need without it being overwhelming. It really means a lot to me when I hear from patients that I explained something well, even though I’m sure they’re saying that to a lot of their providers. Just telling me, “I understand what you’re saying” goes a long way in making sure that a patient feels empowered and feels that they have the autonomy to really take on their journey.

Ms. Skefos: Absolutely, that’s such a special part of our job. I think for me, one of my favorite moments or experiences as a genetic counselor—in addition to what you said about a patient just saying, “I get it, that makes sense”—is when I see a patient’s family member for predictive testing. That’s really a full-circle moment for us as genetic counselors because it shows that the patient who we initially met with understood the implications of their results, communicated that with family—which we all talk with our patients about—and that the family member followed up with that and chose to come see us themselves. I think that’s a really, really special part of our job where we can see the impact that we’re having not only on our patient, but on our family members as well.

Ms. Abdel-Salam: I love that too. I love when I get a phone call from someone saying their so-and-so’s daughter. I’m like, “Oh my gosh, your mom actually talked to you about this and you’re wanting to do something about it.” It feels really good.

Ms. Skefos: It’s really cool.

Ms. Abdel-Salam: Well, I loved talking with you, Catherine. I’m glad we were able to give a good introduction to what we do, and I’m excited to dig deeper into some of the different spaces and topics that we get to touch.

Ms. Skefos: I’m looking forward to it too. This was fun having this conversation with you, and I’m looking forward to our next one.

Oncology Data Advisor: Amazing, thank you both so much. This was such a wonderfully informative conversation about how you entered the field of genetic counseling, what you do on a day-to-day basis, and how you help patients navigate all of these aspects. Thank you so much for coming on to explain all of this, and like you said, I’m looking forward to working with both of you on the Editorial Board and digging a little bit deeper into the diseases that you see. Thank you both again, this has been such a wonderful conversation.

About Ms. Abdel-Salam and Ms. Skefos

Hiam Abdel-Salam, MS, CGC, is a Certified Genetic Counselor in the Clinical Cancer Genetics Program at the University of Texas, MD Anderson Cancer Center. She provides cancer risk assessment and counseling for patients in the Breast, Genitourinary, and Pediatric/Adolescent/Young Adult Centers. Her research interests are in the identification of incidental hereditary cancer predispositions in multigene panel testing and communication of hereditary cancer syndromes within families. She has a particular research focus on exploring attitudes and communication about cancer and hereditary cancer risk among racial and ethnic minority populations and improving access to cancer genetic counseling among underserved patients.

Catherine Skefos, MA, MS, CGC, is a Certified Genetic Counselor in the Clinical Cancer Genetics Program at the University of Texas, MD Anderson Cancer Center, where she provides cancer risk assessment and counseling to patients in the Endocrine Center. As a genetic counselor working with both pediatric and adult patients, she helps patients and family members understand and adapt to information about inherited cancer risk and genetic testing. Prior to becoming a genetic counselor, she received an MA in Medical Anthropology from the University of South Florida, where her research focused on health care access and health disparity. Catherine has a special interest in teaching, particularly educating health care providers about the utility of genetic counseling and testing with the goal of improving patient access to genetic services.

For More Information

US Department of Health and Human Services (2024). Genetic information. Available at:

National Comprehensive Cancer Network (2024). NCCN Guidelines: detection, prevention, and risk reduction. Available at:

National Society of Genetic Counselors (2024). Available at:


National Society of Genetic Counselors (2024). Find a genetic counselor. Available at:

Transcript edited for clarity. Any views expressed above are the speakers’ own and do not necessarily reflect those of Oncology Data Advisor. 

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