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Genetic and Environmental Risk Assessment and Colorectal Cancer Screening

TO THE EDITOR: Weinberg and colleagues' article (1) highlights the complexities of using genetic polymorphisms and their associated cancer risk to encourage lifestyle modifications. The study attempts to consider risks, benefits, and potential barriers to personalized medicine and associated patient and provider uptake. The authors discuss their rationale for using trained nurses in lieu of genetic counselors, stating that the number of genetic counselors seems inadequate to meet health service needs even in high-risk settings, citing a reference from 1990 (2) that does not reflect current data. Currently, there are more than 4000 certified genetic counselors in the United States, all of whom are trained to provide a cancer genetics consult and approximately 30% of whom report cancer genetics as their primary specialty (3). The certified genetic counselor workforce has increased by 75% since 2006. Annual growth in the profession is trending upward of 7% to 10%; this finding partially reflects the increase in the number and capacity of training programs as we prepare for future needs. Recently, genetic counselors were cited in the Top 10 Fastest-Growing Careers (4). According to the U.S. Bureau of Labor Statistics, the genetic counseling profession is predicted to increase 41% by the end of 2022, a rate much faster than that of other health care professions (5, 6). Access to certified genetic counselors is excellent. Approximately one half of respondents to the National Society of Genetic Counselors' 2014 Professional Status Survey report availability for a new patient consultation within 1 week (3). Alternative genetic service methods, including video or telephone genetic counseling, increase access to patients in underserved areas. A directory of genetic counselors is available at www.nsgc.org. The authors state that a lack of familiarity with genomics on the part of patients (and providers) has been cited as a concern limiting the effect of genetic testing. This lack of familiarity and the mounting complexity of genetic and genomic testing highlight the importance of collaboration between genetics and genomics and medical specialties. The National Society of Genetic Counselors welcomes opportunities to partner with health care organizations to provide genetics and genomics education. Genetic counselors are essential members of the health care team and work with our physician partners to provide counseling, enhance overall patient care, accelerate educational opportunities for clinicians, and facilitate appropriate utilization of genetic services and testing to ensure sound medical management and decision making. The National Society of Genetic Counselors suggests that health care organizations and providers unfamiliar with genetic services work with genetic counselors to ensure delivery of high-quality genetic services to patients.