Genetic Counselling & Genetic Testing

What is Genetic Counselling? Education and guidance offered by professional advisors in order to help people make informed decisions based on genetic knowledge. Providing information about genetic conditions with counselling support so that individuals can make personal decisions about the management of their health, their children’s health, or their pregnancies.

What is Genetic Counselling? Cont. Advisors help the person understand the meaning of specific information in their genes.

What is Genetic Counselling? Cont. Genetic Counselling may be helpful to people interested in knowing more about: The chances of having or developing an inherited condition A family history of cancer A family history of a condition that might be inherited The chances of having a child with an inherited condition Prenatal testing for high risk pregnancies

What is a Genetic Counsellor? Health care professionals with specialized training & experience in the areas of medical genetics and counselling. Provide individuals/families with information on the nature, inheritance, and implications of genetic disorders to help them make informed medical and personal decisions.

What do Genetic Counsellors do? Identify individuals and/or families who may have, or be at risk for, a genetic condition Investigate the problem present in the family Interpret information about the disorder Analyze inheritance patterns and risks of occurrence and recurrence Review available options with the individual/family in a manner that promotes informed choice

What do Genetic Counsellors do? Cont. Serve as patient advocates & refer individuals/families to available support services Serve as educators/resources to other healthcare professionals & the general public Combine aspects of social worker/counsellor & medical professional

Types of Genetic Tests Tests based on DNA, RNA, chromosomes, protein Testing parents for carrier status Prenatal testing Neonatal testing Testing in children Presymptomatic screening for late-onset disease Presymptomatic screening for complex disease susceptibility

Testing Parents for Carrier Status Carrier testing is used to identify people who carry one copy of a gene mutation that, when present in two copies, causes a genetic disorder. Offered to individuals who have a family history of a genetic disorder & to people in ethnic groups with an increased risk of specific genetic conditions. If both parents are tested, the test can provide information about a couple's risk of having a child with a genetic condition.

Testing Parents for Carrier Status Tests on parents can be performed on a sample of blood, hair, skin, amniotic fluid or other tissue. Sample is analyzed for abnormalities in chromosomes, DNA, or proteins Family trees (pedigree) often composed to trace the spread and hereditability of gene/disease

Testing Parents for Carrier Status Pedigree Analysis: Pedigree diagram is used to represent/map out genetic relationships Used to determine the mode of inheritance (autosomal dominant, autosomal recessive, X-linked recessive) of genetic disorders

Prenatal Screening Prenatal screening tests are used to check the health of a developing baby. Tests usually done early in pregnancy (<20 wk) A screening test does not tell for sure that the developing baby has a certain problem, but it does tell if it is more likely and if further testing is necessary.

Most Common Types of Prenatal Genetic Tests Amniocentesis The most common prenatal test performed today (Morris, 1993) Estimated fetal loss - 0.5% (O’Connor, 1989) Diagnostic test that involves examining cells shed naturally from the fetus into the amniotic fluid Can indicate chromosomal disorders like Down syndrome, genetic disorders like Cystic fibrosis, and neural tube defects like spina bifida Usually for women 35+ or if questionable results from ultrasound

Most Common Types of Prenatal Genetic Tests Chorionic Villi Sampling Can be performed at a much earlier age of the fetus development compared to an amniocentesis test (as early as 8 weeks) Fetus is located through ultrasound; needle passed through the abdomen and fragment of chorionic villi (finger-like projections from the placenta) are extracted which carry identical genetic information Risk of having a miscarriage is slightly higher than amnio. (approx. 0.5-1%)

Most Common Types of Prenatal Genetic Tests Alpha-fetal protein Sampling (AFP) A blood test from the mother that determines the variation of high and low concentrations of alpha-fetoprotein in the mother’s blood that can indicate a risk of fetal genetic abnormalities Measured middle of the second trimester (14-16 weeks) Elevated levels may be caused by neural tube defects including spina bifida, anencephaly, and abdominal wall defects Abnormally low levels in Down syndrome and trisomy 18 High false positive rate Tumour marker

Other types of Prenatal Screening Maternal Serum Screen (MSS) Uses a blood sample from the mother’s arm to measure the amounts of special substances found in every pregnant woman’s blood

Neonatal Testing Newborn screening – process of testing newborn babies for treatable genetic, endocrinologic, metabolic, and hematologic diseases. Ex. Phenylketonuria (PKU) screen Obtaining blood sample from newborn baby’s heel to screen for PKU Autosomal recessive disorder characterized by deficiency in hepatic phenylalanine hydroxylase necessary to metabolize phenylalanine (Phe) and tyrosine (Tyr) PAH deficiency causes accumulation of Phe which can be detected in urine Left untreated, condition can cause problems with brain development, leading to mental retardation, brain damage and seizures Easily controlled by low Phe diet; Damage is irreversible, hence early detection is crucial

Testing in Children If a child does not reach specific milestones (ex. Sit independently by 4-7 months, reach and grasp objects by 3 months, double birth weight by 4 months...) there may be cause for concern and health care professional may direct family to specialist/genetic counsellor

http://www.signaturegenomics.com/prenatal_microarray_services.html http://thoroughgen.com/about-us.html https://www.23andme.com/ http://www.illumina.com/products/human_omni_express_beadchip_kits.ilmn https://www.youtube.com/watch?v=lVG04dAAyvY

Genetic Counselling as a Career Genetic counsellors complete a Master of Science degree in genetic counselling from a recognized university program. Typical educational backgrounds include: biology, nursing, social work, psychology... Training consists of course work in genetics & counselling theory, as well as clinical rotations within genetics departments. In Canada, most genetic counsellors are certified by the Canadian Association of Genetic Counsellors.

Schools/Programs in Canada UBC, U of T, McGill Genetic Counselling (M.Sc.) LENGTH OF PROGRAM 2 years NUMBER OF STUDENTS ACCEPTED EACH YEAR Approx. 6-10 TUITION Approx. $30,000 INCOME $60, 000 - $100,000 depending on location

Schools/Programs in Canada The Michener Institute (Toronto) Genetics Technologist (Diploma) Processing specimens for genetic analysis Analyze chromosomes, DNA and RNA for genetic abnormalities and help diagnose, treat and monitor disease. REQUIREMENTS: Bachelor of Science degree with two or more university-level genetics courses (either in Human Genetics or Molecular Genetics). NUMBER OF STUDENTS ACCEPTED / APPLYING EACH YEAR: 16 out of 50 interviews LENGTH OF PROGRAM: 16 months $8,500 INCOME: $65,000 per year, depending on location.

Schools/Programs in Canada BCIT (Vancouver) British Columbia Institute of Technology Genetics Technologist (Diploma) Genetics Technologist (Diploma) Processing specimens for genetic analysis Analyze chromosomes, DNA and RNA for genetic abnormalities and help diagnose, treat and monitor disease. REQUIREMENTS: Bachelor of Science degree with two or more university-level genetics courses (either in Human Genetics or Molecular Genetics) with a minimum grade of 60%. LENGTH OF PROGRAM: 16 months TUITION: $8, 500 INCOME: $65,000 per year, depending on location.

Other Career Options Medical Geneticist (MD) Clinical/academic geneticist. Oversees patient diagnosis, treatment & referral. Often leads a multidisciplinary team. An experienced MD with specialization in clinical genetics. LENGTH OF PRORGRAM 4 year MD + 6-9 years specialty & subspecialty

Other Career Options Graduate School (PhD) Geneticist/molecular biologist. Wide field of study, from basic cellular and molecular biology, to searching for diseased genes, to tracking spread of disease. LENGTH OF PROGRAM 4-6 years INCOME Pharma. Industry: $100, 000+ Academia: ???

Other Career Options Intellectual Property Law MSc/LLB/LLM/Patent Agent Scientific background (BSc/MSc) with a law degree and specialization LENGTH OF PROGRAM 3 Years (Law School) INCOME Pharma. Industry: $100, 000+ Private firm: $80, 000 - $500,000+

23 and the RCMP http://www.rcmp-grc.gc.ca/nddb-bndg/index-accueil-eng.htm