The genetic counselling of inherited cancer: a three step procedure with rising levels of information and consent.

The availability of genetic tests which allow the identification of individuals at high risk of inherited cancer has led to a growing interest for counselling procedures with the corollary of important psyco-relational, ethical and legal issues. In our oncology unit, we have developed an original counselling strategy targeted to all patients accrued for cancer diagnosis or treatment In our approach every opportunity for educational or preventive aim is considered and is integrated in the whole patient management, even indepently from the findings of genetic testing. We have developed a counselling flow-chart which specifically involves the counsellor intervention in all the predictable situations with different and rising levels of information and consent. The critical points for evaluation of psychologic distress and specific intervention have been also identified The whole procedure has been arranged in three operative-steps. All cancer patients are accrued to the first step which is finalized to the identification of candidates to the genetic testing The second step is targeted to the proband and involves the molecular testing together with the pre- and post-test counselling The third step, which follows the proband consent, is targeted to the non-affected relatives at risk of carrying the inherited cancer susceptibility mutation and also involves the pre- and post testing counselling together with the molecular genetic analysis A specific surveillance program is issued for the relatives germline mutation carriers. General or specific procedures are considered at this point also for non-mutation carriers or for individuals who refused genetic testing. We think that our three step procedure will be useful to integrate the molecular genetic testing in a adequate information and consent milieu for the assessment of genetic risk of cancer