Episode 19: Genetic Counseling and CUSP

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Hi everyone. And welcome back to cancer uncovered. My name is Laura and I am part of the lifts drug cancer institutes at Dell medical school. Today, we are going to uncover the fascinating, impactful in cutting edge field of genetic counseling. Our guest for this episode is Kalisi. Certified genetic counselor in the oncology clinic here at UT health.

Austin. She’s going to tell us more about her own career path. We’ll hear an example of a typical visit with a patient and their family. And she’ll tell us about the new clinical undergraduate shadowing program for students interested in genetic counseling. As usual we’ll end with advice and wisdom for anyone who may be interested in this field or in healthcare in general.

So first let’s start off with hearing about what genetic counseling actually is. Here’s Kalisi. My name is Kalisi Logan, and I mentioned at a counselor here at live strong cancer institutes. Genetic counseling in general is a field aware. We are helping patients understand their risks for genetic conditions.

And we can also explain the different testing options that are available for genetic tests. There are many specialties of genetic counseling. The main three is cancer, prenatal, or reproductive genetics, and also pediatric slash medical genetics. And I work as a cancer genetic counselor. And so many of my patients are people who either have a personal or family history of cancer.

And so we talk about number one, how does having a family history of cancer affect their own cancer? And if genetic testing is something that might be helpful to understand what their risks are, but we talk about the pros and cons of doing genetic testing as well. And if they decide they want to do genetic testing, when I also help coordinate the testing for them, that’s really helpful.

Thank you. And how did you end up going into this? My path to genetic counseling. Wasn’t a direct path, which is pretty common. I always knew that I wanted to work in the healthcare setting. And when I went to college, I was kind of set on being pre-med. But after taking a few classes and also getting some experience working on the freshman research initiative at the university of Texas, I found that I had a very strong passion, not only for research, but also genetic.

And so at that point, it really became a question of how can I focus on genetics and still work in the healthcare setting. But eventually what happened is I met with the career counselor at UT and she was the one who brought up genetic counseling. ’cause, it was just something that aligned with my interests.

I was like, yeah, this makes a lot of sense because what genetic counseling is, is yes, it’s a healthcare profession, but the focus is not only on the medical aspects, but also the psychosocial aspects of healthcare. And that was something. I really enjoyed. And I found out that as a genetic counselor, you can participate in research.

It’s not something that you have to have a PhD degree in order to do research. And so I really liked that aspect of it. And so once I did a few informational interviews with some genetic counselors here in Austin, I thought, okay, this is the field for me. And then I worked as a genetic counseling assistant for a year after graduating to learn a little bit more about the profession from the behind the scenes part of being a genetic counselor.

And I really enjoyed that experience as well. And that really solidified my plans to pursue genetic counseling. And how did you decide to work with oncology patients versus the other categories? Yeah. So when I was working as a genetic counseling assistant, it was actually for a group of cancer, genetic counselors.

And I remember at the time thinking, yeah, I don’t think I’d want to work in cancer. That seems like, you know, really depressing. I’d probably want to work in a different field, but in my experience, as a genetic counseling assistant and working with a team of cancer, genetic counselors, you really get to see what an impact you have on patients and their family members.

And that’s what I really took away from that aspect of genetic counseling. So kind of put it into a different perspective. Then the other fields, cancer, genetic counseling, many of the genes are inherited in an autosomal dominant fashion. And basically what that means is whenever you have a patient who has a genetic predisposition for cancer, it’s likely that they have a parent or a sibling who is also affected.

And so that’s what I really liked about the family aspect or working as a cancer genetic counselor. Could you give us an example of one of your sessions with patients, maybe a recent one, or maybe one of the ones that stuck with. One of my patients who was actually a cancer patient in our clinic. She had a history of breast cancer, but also had a family history of pancreatic cancer.

And with that history that actually is more suspicious for hereditary cancer syndrome. And so we did order genetic testing and she did happen to have the predisposition to develop. Unfortunately shortly after we ordered the genetic testing, she did pass away. And so whenever we have the results, it was something that I delivered to her daughter who was her caretaker at the time for her daughter.

She was really happy to have that information, even though her mother had passed away from the breast cancer. And that essentially meant that she had a 50, 50 chance of also carrying that genetic predisposition. From that point, it was a matter of okay. Testing the daughter and also her brother to see if they have the same predisposition that their mother had.

And my patient who was now, the daughter actually did test positive courses for brother didn’t. And so at that point was now a question of testing the grandchild. And so they eventually tested negative. So it was great news because she was very worried mother, but I think that’s like a really good case that, you know, really demonstrates how you’re not just dealing with the patient in front of it.

You’re dealing with the whole family. Well, most cases of genetic counseling, you’re seeing one patient and then you order the genetic testing and you probably won’t see them again, because most of the time they test negative and they don’t have a genetic predisposition, but for the patients who test positive and you actually have to go on and test their family members and actually get to people or their family, I find that really rewarding.

Um, because you’re making connections with people at so many levels. Yeah. What are some of the myths about genetic counseling? So I wouldn’t say that there are so many myths about genetic counseling itself, just because not many people know about genetic counseling to have any. But there are a lot of myths about genetic testing.

And I think just as medicine continues to incorporate genetic testing, there’ll be more and more myths. But one of my favorite myths is that genetic testing is going to give you all the answers. And unfortunately, that’s not the case. Sometimes it does provide more information, but it can also provide more uncertainty.

So that’s, that’s one of the big things that we talk about when we’re talking about the pros and cons of doing genetic testing is desk. This could provide some more information, but could also give you more uncertainty. So you have to weigh the pros and cons. Another myth about specifically genetic testing in the realm of cancer is sometimes my patients think that they’re doing a test.

That’s going to tell them if they have kids. Whereas I always have to make sure that they understand this. Isn’t a test to see if you have cancer. This is just a test. That’s going to tell us a better understanding of what your risks for developing cancer are. Another myth is if they test positive, that means that they are going to get cancer.

And that’s not the case, because again, this is talking about a genetic predisposition. So we’re talking about someone having an increased risk, not so much saying if you have a positive test result on one of these tests that you will for sure get cancer. So that’s, again, one of the common myths and we have to kind of talk people off the ledge whenever they test positive and just reframe things to say this doesn’t mean you’re definitely going to get cancer.

This is something that you were born with and we’ve had your whole. And now we just know about it. And so now that you know about it, you can take measures to better take care of you and prevent or reduce the risks of developing cancer. Definitely. And I can see how that would bring in that psychosocial component that you mentioned earlier, because that’s all very confusing and stressful.

How does access to genetic counseling influence healthcare disparities? So, because genetic counseling is all about educating the patient about the pros and cons of doing testing and also allowing them to. Make decisions for themselves about whether or not to move forward with genetic testing. I think that because we’re providing an increase of knowledge about the genetic testing options and options for screening, then we are able to.

Level out the disparities that we see in healthcare that are just simply due to education, but then also decrease incidents of cancer or mortality from cancer because patients again have a better understanding of their work. Access to genetic testing is far and wide, but the actual counseling to make sure that patients are understanding what this genetic test result means for them isn’t as far and wide as the genetic testing, but access to genetic counselors has increased tremendously over the years.

So just looking at the genetic counseling workforce since 2010, it has done. But used to be quiet, one limitation to access to genetic counselors. But we’re seeing that that’s not really the case so much, especially if you can access genetic counselors via tele-health, if not someone that is working at your local medical center.

Yeah. Yeah. Interesting. And I think that leads into our next question of how has this field changed over time? I remember there was a time where it was very commonplace for people to see that there is a shortage of genetic counselors and that can definitely still feel that way. But we’re also seeing that there is an increasing number of genetic counseling programs.

And so with that increase, I think that there will be less so a shortage of genetic counselors. Of course, we’ll still have barriers of access to genetic counselors, maybe locally. We know that telehealth is something that more and more people are getting acclimated to because of the pandemic. And a lot of genetic counselors are available via tele-health in terms of where I see it going.

I definitely think that the field will continue to grow. I also think that the areas that genetic counselors practicing will also increase. So back when genetic counseling. Started initially it was mainly focused on the prenatal realm. And now we have the main three, which is prenatal cancer and pediatric or medical genetics.

But over the years, there have been more and more specialties that have become more common for genetic counselors to practice in such as cardiology and neurology. And I think that that will continue to grow not only the genetic counseling field, but also the access to genetic counselors. All areas of medicine, definitely.

What is the path to become a genetic counselor to become a genetic counselor? It is a master’s degree. There are about 50 of those in the country. Now, many of these programs require that you have exposure to the field and have a good understanding of genetic counseling. All of them are going to require that you have a bachelor’s degree and have taken a course in genetics.

That’s like. So it’s not necessarily a requirement that you have to have a bachelor’s degree in genetics, but there are a few courses that many programs acquire, including genetics statistics. Biochemistry is a common one. Psychology is another one. And so if someone is wanting to become a genetic counselor, you don’t have to have a degree in genetics.

Would you take the courses that are listed as prerequisites for the programs? That’s sufficient. I had a classmate who was an English major and when she was in school and she just had all the pre. That she needed for genetic counseling and she did great in the program. Of course, every program is going to have the coursework that’s required.

So just learn about being a genetic counselor and knowing the different genetic conditions that are pretty common in practice, but the clinical rotations as a major part of getting your degree in genetic counseling. So when I graduated, it was required for students to get 50 cases. Um, during their two years of grad school, in order to meet the graduation requirements.

For me, it seems like very little, and that’s why many programs actually have a lot more than finger cases is what students end up seeing. Just in general, most programs are very similar because they are all credentialed by the same group. And then everyone takes a board exam that’s given by the American board of genetic counseling.

And where did you go? I don’t think you told me. Yeah. So, um, I went to the Icahn school of medicine at Mount Sinai located in New York city. Oh, cool. What was that like? That’s really different than Austin. Yes, it was great. I mean, the main thing that drew me to that program was the availability of specialty OTs.

Okay. So, as I mentioned before, there are three main fields of genetic counseling. Every program is going to have rotations in those fields, but I was interested in also getting to shadow or practice in the field of cardio genetics. And so that was one of the few programs where you were guaranteed to rotate through a cardiovascular genetics clinic.

And in addition to that, we were. Also rotating through other specialty clinics. Like we had a metabolic genetics rotation. Another one was working as part of a cystic fibrosis clinic. So just kind of seeing, not only the role that a genetic counselor plays in that role, but also the other providers who are involved in their care management was really interesting.

So after someone completes their master’s degree, Many places of work will require for you to be a board certified genetic counselor. And so you have to take your boards exam, which is offered currently twice a year, once in, I believe September and again in February. And so after taking that exam, you are a certified genetic counselor.

And then from that point, moving forward, that sort of vacation lasts for about five years. And so during those five years, you will have to get what’s called continuing education. Which just means you have to make sure you’re staying on top of the latest and all things genetics. And that’s how you maintain your certification to be a certified genetic counselor.

Right. Okay. So now we’re going to switch gears a little bit to talk about cusp. Could you tell us what cusp is and how it started first? Yes. So cusp is our clinical undergraduate shadowing program. And it was something that we created because with the few amount of genetic counselors were available here in Austin to offer shadowing opportunities for undergraduates who are pursuing genetic counseling.

We wanted to create a space for that. And so we started it at first. We just had a few students, I think it was five. And we have them shadow me over the course of a week. We wanted to make sure that these students were getting the shadowing experience that they needed in order to satisfy requirements for their graduate school applications.

The main point of getting that shadowing experience is just to make sure that those students understand the role of a genetic counselor. We’re doing it again this summer, and we’re expanding it to eight students. And. We’re going to also focus on making sure that any students who are disadvantaged or underrepresented in the field of genetic counseling will be able to get these shadowing requirements completed because there’s a lot of under-representation of minorities in the field of genetic counseling.

And we know that just getting into grad school is going to be one of those barriers. And we don’t want the lack of shadowing experience to be the barrier that keeps someone from getting into. What do you think are some other barriers to that besides shadowing? It’s definitely going to be that a lot of people learn about genetic counseling pretty late.

So, as I mentioned, her, myself, wasn’t pursuing genetic counseling until like a couple of years into college. And, you know, at that point, if you find out about genetic counseling after you graduated or when you’re close to graduating over. Then you might have to take additional courses for genetic counseling programs because there are three requisites for that.

But another common prerequisite is having advocacy experience. So some examples of the advocacy experience are like working at a hotline, working at a domestic violence shelter, or with people who have intellectual disabilities. Those are all examples of advocacy experience. That takes time. Right. And it’s all volunteer, right?

It’s not exactly the cost of applying to genetic counseling programs is a lot, depending on how many programs you want to apply to every program is going to have their own application fee. And so the more programs that you apply to the higher it’s going to cost for someone to apply. And just in total, And then on top of that, you have to take a GRE test, which actually many programs are not requiring any more, which is.

But taking a GRE test and also sending those scores to every school, sending your transcripts to every school that, that all costs money. I know that that definitely contributes to the lack of diversity in the field. So again, what’s great is that many programs aren’t really requiring GRE scores anymore.

That in itself is a big barrier because maybe you have the privilege to hire someone who can help you study for the GRE or someone else. Another thing that programs are doing to increase the accessibility is that program interviews are now being done virtually after the pandemic, because that was another cost where I did end up interviewing at six different schools.

And thank goodness I was working as a genetic counseling assistant. So for me, my manager was happy to let me take time off, to go to these interviews and. Since I was actually living at home while I was at Geneva county assistant, the income that I got as a genetic counseling assistant went and paid for all the applications and the interviewing.

And so I was fortunate to have that, but just thinking about even someone who is in school, maybe working their way through school, who is going to have the time to go and interview at six or seven programs without worrying about. Falling behind in classes to getting good scores on your cars. It’s like so much stress on top of the stress that we already have just going through college.

Right. I’m glad that they’re making changes. What would you tell learners who are considering a career in genetic counseling or healthcare in general? What I would say for anyone who’s just considering a career in healthcare is just to know that there are so many different. Ways that you can be involved in healthcare.

I went into college thinking, like I knew about nurses, knew about doctors and hadn’t really given much thought to the other ways that you can be involved as a healthcare professional. The possibilities are really limitless. It seems, um, and to just really explore the different fields that are available.

Now for someone who’s specifically interested in genetic counseling, I would say just to really get involved with the genetic counseling community any way you can. So it doesn’t really mean like you have to make any commitments. There are a lot of different ways to get exposure, but it’s more than just shadowing a genetic counselor.

You can follow genetic counselors on Instagram, take talk like they’re out there and they can tell you all about genetic counseling and you learn a lot just from those little tidbits of information that you get from social media. If you’re looking for more educational outlet, there are webinars that are available for students who are considering a field in genetic counseling.

So just really explore those options so that you can learn as much as you can about the fields, just to see if it’s a good fit. So, yeah, I think genetic counseling in general is a great field for anyone who likes to learn into continue learning because the field of genetics is constantly changing or learning so much just as we learn more about genetics itself.

And then when it comes into practice and medicine and you learn. The ways that it can be applicable. And so if someone is excited about things changing often, and I guess getting to be part of a cutting edge field in genetics is a great place. Um, and you don’t have to be a genetic counselor a lot of times.

Careers within genetics itself too. Like what? So one of the students that I previously talked to who was looking into the field of genetic counseling, she actually ended up working. It was something related to precision medicines. That makes sense. Just that term keeps coming up. Precision medicine. And I think that’s actually where medicine is going.

Precision medicine is the hot topic right now. And that’s part of the reason why genetics is constantly evolving is because more and more people want to be able to offer. What’s called precision medicine. And genetics is a strong component of that. What we do even in our clinic, I think you can. Call precision medicine.

So for example, when we see a patient and we do genetic testing and we find that they have an increased risk to develop certain types of cancers, instead of offering them the screening that is recommended for someone in the general population. For example, use breast screening for women. A woman in the general population is recommended to start screening at the age of 40 and to do a mammogram every year.

Now we know that if someone has a family history of breast cancer, that is significant, they might actually recommend that that person have a mammogram and a breast MRI, every. So you can kind of think of that as precision or personalized medicine, because we’re not just treating everyone the same anymore, right?

Like we’re taking into consideration other factors, like in this case, family history now, so take it one step further. If we do genetic testing and find that that person has a genetic predisposition to develop breast cancer. Now we say, okay, because of this genetic test result, we recommend that you start your breast MRIs at the age of 25.

And do those every year. When you turn 30, we want you to start your mammograms and you will continue to do both of those every year. So even when we’re doing. And our clinic can be considered precision medicine, personalized medicine, and people hear that and think, wow, you’re like really cool, which it is really cool, but it could be as simple as taking a genetic test and saying, okay, now we know this about you and this is what we’re going to do to change your health care management to better take care of you more personable, right?

Yeah. That’s so true. I’m really glad that. Because precision medicine sounds like this lofty term, but then when you explain it, of course we’re doing that in our, yeah. So like in terms of other fields that you can work in related to genetics, like you can get a PhD in genetics and that would be more on the research side, but still involved in medicine.

And we have our molecular tumor board, which is a great example of precision medicine. We’re using specific characteristics that are identified through genetic testing of someone’s tumor to make decisions about their treatment. So, you know, precision medicine is already happening. It’s not something that’s like.

Coming soon to you, like later on it’s, like you said, it’s a very lofty term. And people think that it’s like something that’s way off in the future, but we are always doing it and we’re doing it in our clinic every day. It’s and that’s just the world that we live in now. And so that’s why I tell people that if you’re really interested in being part of something that is constantly changing, constantly evolving genetics is a great place to be.

Well, I’m all excited about this episode. I think this’ll be amazing. Yeah. Thank you again for doing this. Thanks for having me on the podcast. I would just say if there’s anyone out there who has questions about genetic counseling to just go to our website, it’s the cusp website. We do have a listserv that is available for people who are interested in pursuing genetic counseling.

And through that listserv, I send out different webinars or. Job opportunities that I come across for genetic counseling assistance or GCAS. So again, if that is something that is of interest, we are more than happy to spread the word about all things, genetic counseling, and just subscribe to our list of thank you to Khaleesi Logan for sharing her time and expertise with us today.

Take a look in the bio. Episode for the link to the cusp website, which also includes information about the genetic counseling list. Serve. If you have questions for Khaleesi or suggestions for future episodes, please email us@livestrongcancerinstitutesatdellmeddotutexas.edu. And make sure institutes is plural.

If you were intrigued by the idea of precision medicine. Make sure to tune in next month as well, because we’ll be diving deeper into this topic with Jeanie Coel skeet PhD professor in the department of oncology associate director of cancer, clinical genomics at the LCI and the lead for the molecular tumor board.

You can find out more about the lifts term cancerinstitutes@dellmeddotutexas.edu and the live strong cancer institutes clinic. At UT health, austin.org. You can also follow our chair and director Dr. Gill Eckhardt on Twitter at S Gail Eckhart. Eckhart is spelled E C K H a R D T. I am and this is cancer uncovered.

Thank you for listening. .