What is genetic counselling?

If there is a risk that cancer may run in your family, your GP can refer you to a genetics specialist so you can discuss your possible risk of cancer.

About genetic counselling

If there is a risk that cancer may run in your family, your GP can refer you to a genetics specialist. This could be in a family cancer clinic or a cancer genetics clinic.

Genetic counselling means meeting with the specialist to discuss your possible risk of cancer.

If you are referred to a genetics specialist

You may wait for a few weeks or months before the clinic contacts you. They may send you a family history form to fill out before you have an appointment. This will usually ask you:

  • the names and ages of your family members
  • their relationship to you
  • whether they are on your mother’s side or father’s side of the family
  • what cancer types your relatives have had
  • the age they were diagnosed.

It is not always possible to fill out the form completely. It may be difficult to contact or speak to some of your family members. Sometimes talking about a family member or their illness is painful or upsetting. Some relatives may not want to know more about possible cancer risk in your family.

Do not worry if you cannot get all the facts, but try to complete the form as much as you can. The team at the genetics clinic will understand.

A genetics specialist uses the information you give to work out if there might be an increased risk of cancer in your family. They may also use information from public records or a cancer registry to find out more about the cancers in your family.

Sometimes the genetics specialist can find useful information about a relative’s cancer diagnosis in their health records. If the relative is alive, they can only do this with their permission.

If an inherited cancer gene is unlikely

The pattern of cancer in your family may not show that an inherited gene mutation is likely. In this case, the clinic may decide you are unlikely to have a high risk of cancer and do not need an appointment to see them. They will usually tell you this in a letter. If you have not heard from the clinic after a few months, check with your GP.

If you have questions about their decision, you can call the genetics clinic. The letter they send usually includes a contact number for a genetics specialist.

If another diagnosis of cancer is made in your family in the future, talk to your GP again. This may give them more information to check your level of risk.

Having genetic counselling

If you are given an appointment, you will meet a genetics specialist. This is called genetic counselling.

The meeting will last between 30 to 60 minutes. The genetics specialist will draw a diagram called a family tree. It will show all your close blood relatives and their illnesses. The genetics specialist uses this to assess your risk of developing cancer.


The diagram shows an example of a family tree for a person who is worried about the history of cancer in their family. The tree shows all the relatives of the person – her grandparents, parents, aunts, uncles, siblings, cousins and children. If a relative has had cancer or died, it is written next to their name.

During the meeting, you will be able to discuss:

  • whether you are likely to have a higher than average risk of certain types of cancer
  • whether a genetic test is possible and useful in your situation
  • the benefits and limits of genetic testing
  • ways of managing your cancer risk, including information about symptoms of cancer, cancer screening and risk-reducing treatments.


Getting the most out of your meeting

It is a good idea to write any questions down before you meet the genetics specialist.

Here are some questions you may want to ask:

  • What is my risk of getting a particular cancer?
  • How sure are you about my risk?
  • Is there anything I can do to reduce my risk?
  • Who else might be at risk in my family?
  • Do I need to tell anyone in my family?
  • When and how should I tell my children?
  • If I do not have a high risk of getting cancer, should I have any follow-up appointments?
  • What shall I do if I want a test or screening, but it is not offered to me?
  • Do I have to tell insurance companies about my family history or genetic tests?

It may be helpful to bring someone with you to the meeting, such as a partner, family member or friend. You can share your thoughts afterwards.

If there is something you do not understand, tell your genetics specialist so they can explain. You can also contact them again if you have more questions. You will usually get a letter after the meeting that lists all the important points.

Assessing your cancer risk

This means estimating your risk of getting certain cancers that may run in your family.

This happens at the genetics clinic when you meet the genetics specialist. Your GP may also do this when they decide whether to refer you to a genetics clinic.

To assess your risk, they look at:

  • how many of your relatives have had cancer
  • what age they were when they got cancer
  • how many of your relatives have not had cancer
  • whether there have been any rare cancers in your family
  • whether there have been groups of cancers in your family, for example breast and ovarian cancer or bowel and womb cancer
  • your age.

Based on this information, they may explain that your risk of getting cancer is one of the following.

  • Average or low risk (population risk)
    Your risk is the same as, or close to, anyone without a family history of cancer.
  • Moderate (raised) risk
    Your risk of some cancer types is a bit higher than average. It is not likely there is an inherited cancer gene they can test you for.
  • High risk
    You have a higher risk of developing some cancer types in your lifetime. This does not mean you will definitely get cancer. There may be an inherited cancer gene they can test for in your family.

Knowing your cancer risk can help you decide what to do to reduce it. This might include: