Genetic counselling in the context of a recent cancer diagnosis and Hereditary Non-Polyposis Colorectal Cancer: helpful or harmful? A case report
Background: Little is known about how a recent diagnosis of cancer in association with suspected Hereditary Non-Polyposis Colorectal Cancer syndrome (HNPCC) impacts on the genetic counselling process.
Case example: The patient presented for genetic counselling within three months of a diagnosis of an HNPCC spectrum cancer.
Issues: The patient’s apparent difficulty in comprehending and retaining information about the effects of HNPCC is discussed in the light of her recent cancer diagnosis. For the genetic counsellor, this situation presents a dilemma: how best to ensure that the patient understands the implications and syndromic issues of HNPCC, when the patient is preoccupied with immediate cancer-related decisions and anxieties?
Discussion: There is evidence that for individuals with breast cancer, genetic testing too soon after diagnosis may not be optimal. It has been suggested that consideration should be given to deferring genetic counselling until the individual is less overwhelmed by the many issues attendant upon a diagnosis of cancer. If HNPCC is suspected, however, there are good reasons not to delay genetic counselling. People with HNPCC are at significant risk of developing new cancers and appropriate screening should be implemented at the earliest opportunity. The medical management issues for people with HNPCC must by necessity outweigh concerns about the optimal timing of genetic counselling.