Oncogenetics service and the Brazilian public health system: the experience of a reference Cancer Hospital

Abstract

The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH). The Oncogenetics Department (OD) of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i) genetic counseling, ii) preventive examinations and iii) genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly) of two visits. In 2014, 614 individuals (371 families) were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system.

Identification of hereditary cancer in the general population: development and validation of a screening questionnaire for obtaining the family history of cancer

“…All families that fulfilled at least one clinical criterion for any HCPS are being referred to the Oncogenetics Department of BCH, and, after genetic counseling and family history confirmation, they are referred to the Center of Molecular Diagnosis of the same Institution for genetic testing, if warranted .…”

“…One of the challenges for Latin American countries is to introduce hereditary cancer healthcare approaches, with new unexpensive technologies, including screening, genetic counseling, and genetic testing for early detection and diagnosis . In Brazil, there are few specialized services for hereditary cancer predisposition syndromes (HCPS) diagnosis and follow‐up . These services are primarily available at hospitals attached to medical schools and expensive private institutions, mainly located in major population centers, restricting and prejudicing their access .…”

Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome

“…The first appointment at the OD consists of two parts of the GCRA: (a) the nurse consultation, when the oncogenetics nurse collects information regarding patients’ sociodemographic data and FH to draw the pedigree and (b) the consultation with the medical geneticist, where the GT and its implications are discussed. More information about the OD organization can be found elsewhere …”

“…In South American countries, GCRA is a relatively new field, and little is known about the profiles and needs of affected families. In Brazil, the number of GCRA services is limited . It is thus important to characterize and discuss the characteristics of the probands and their families to ensure that professionals can address the challenges of the oncogenetics setting.…”

miRNA expression profiling of hereditary breast tumors from BRCA1- and BRCA2-germline mutation carriers in Brazil

“…Healthy BRCA1/2-mutation carriers were referred after a pathogenic germline mutation was identified in their families and were invited to undergo a mutationspecific predictive genetic test. All information regarding genetic counseling, genetic testing, and the management of the families at risk for hereditary cancer in our institution have been described in detail elsewhere [36].…”