• Open Access

Counseling about Cancer: Strategies for Genetic Counselling


By Katherine Schneider. Wiley, 2001, £29.95(pb), 333 pp. ISBN 0-471-37036-3

Counseling about Cancer (2nd edn) is an excellent resource for genetic counsellors and other health-care professionals working with hereditary cancer families. This book provides a comprehensive and well-organized overview of cancer genetic counselling. It is especially useful for those who do not exclusively specialize in cancer and those just starting out in the field of genetic counselling. This book is designed for professionals and would not be recommended for the general public.

The book begins by providing general information about cancer, including easy to understand reviews of cancer biology, diagnosis and treatment, cancer genetics and epidemiology. After establishing a basic foundation of knowledge, the book shifts to informing the reader on how to set up a hereditary cancer programme and the intricacies of a cancer genetic counselling session.

The first few chapters provide the groundwork that all cancer genetic counsellors should know. It is important for cancer genetic counsellors to understand the terminology and background information presented in these chapters in order to provide the best service to their patients. These sections serve as a useful reference for cancer counsellors at all levels of experience. While the chapters were a little challenging to get through, that is more due to the content than organization or writing style. Schneider does a great job of arranging and simplifying complex information.

The chapter on hereditary cancer syndromes is another excellent resource. Information on cancer risks, available testing and management options are summarized for 30 cancer syndromes, from the well-known syndromes of breast and ovarian cancer or colon cancer, to those that are quite rare. While most of the information presented was correct, I did find some inaccuracies. For example, the cancer risk for Beckwith–Weidemann syndrome was stated as up to 40%, which is significantly higher than the 5–7% risks typically reported in the literature. These numbers are drastically different, and if this book was the sole source used for counselling purposes, the family would be provided exaggerated risks. Therefore, I recommend, as with any information, that more than one source be used. It would also be helpful if the sources from which these risk figures were obtained were referenced, so the reader could assess their validity and have a place to go for more information. Schneider also includes a helpful section that suggests cancer syndromes based on specific cancer type. This would be a very useful starting point when dealing with rare or unusual types of cancer.

The last half of the book focuses on the process of genetic counselling, reviewing the important components of genetic counselling, as well as the related psychological and ethical issues. A full chapter is dedicated to the collection and interpretation of the family history, emphasizing the importance of this information. Schneider discusses classifying families as low, moderate or high risk. Surprisingly, however, she does not discuss the risk assessment models that are widely used by genetic counsellors in counselling patients for hereditary breast and ovarian cancer. While these models are not perfect, they are common tools and should get more attention in a comprehensive text.

Schneider uses several interesting and relevant clinical examples throughout the text to illustrate issues involved in cancer counselling. Many of the issues discussed and scenarios presented can be broadened and applied to genetic counselling for conditions outside the cancer arena. These chapters may be less useful for experienced genetic counsellors, but provide an excellent framework for individuals new to the field.

One topic I was pleased to see included was a review of the basics of setting up a hereditary cancer programme. Schneider covers issues such as clinic staffing, scheduling, logistics and billing, giving the reader a detailed overview of issues that need to be resolved to have a successful clinic.

Schneider has provided us with a wonderful resource that contains the most current information in a rapidly growing field. The presentation of this book is well organized and easy to understand for individuals with medical backgrounds. I would definitely recommend this book to other genetic counsellors and health-care professionals working directly with hereditary cancer syndromes. This book should also be a required/recommended text for all genetic counselling training programmes, as it covers the subject matter from many angles. It may also be useful to non-genetic professionals in primary care. As genetics is becoming more integrated into the primary care setting, it is important for primary care providers to understand the basics of hereditary cancers and cancer genetic counselling to allow them to identify patients in need of formal genetic counselling.