News & Media Gene ‘detective’ assesses risk On Fridays, Region News profiles some of the cool jobs within the Calgary Health Region. Today, we talk a genetic counsellor. April 4, 2008 CHRIS SIMNETT Communications Heidi Hogg is part counsellor, part detective and all compassion. Hogg is a genetic counsellor. She provides people with information on the nature, inheritance and implications of genetic disorders so they can make informed medical and personal decisions. Many genetic counsellors work with people who are pregnant or planning on becoming pregnant. But pregnancy is just one part of the field. Hogg has been a prenatal genetic counsellor but currently works with people who are at risk of developing certain kinds of hereditary cancers, such as breast cancer and colon cancer. “I might meet with a 30-year-old woman who has a strong family history of early-onset breast cancer and she wants to know what her risk is,” says Hogg. “Is she at risk for hereditary breast cancer and is there anything we can do about that?” The field also includes pediatric genetics, adult genetics and subspecialties such as cardiovascular genetics for people with a family history of heart disease and neurogenetics for people with a family history of Huntington‟s disease or other neurodegenerative diseases. Hogg says being called a counsellor is a bit of a misnomer. “Over the years, there‟s been some debate whether that is the best title for us,” she says. “We do provide psycho-social support and we do have some training in counselling. But counselling is only a part of what we do. A large part of what we do is interpret and give information. We take technical medical genetic information that can be very difficult to understand even for us and try to translate it into something meaningful for our patients. “There‟s a lot of detective work,” she adds. “We trace the family tree, track down medical records and assess whether the cancer in the family is likely to be due to a hereditary predisposition. If appropriate, we may offer genetic testing for some families. That‟s typically a blood test where the lab isolates DNA and looks for a change in a gene. It‟s a very challenging and interesting job.” It‟s also rewarding. Hogg, in her current role as a cancer genetic counsellor, can make a real difference in people‟s lives. “With cancer genetics, regardless of whether we offer genetic testing, we can give people practical information about cancer screening that can help them manage or even lower their risk of cancer,” she says. “For people at high risk for colon cancer, we recommend more frequent colonoscopies beginning at an earlier age. That way, colon cancer can be caught at a very early, treatable stage, or a small colon polyp can be removed before it ever even has a chance to develop into cancer. “There are different ways we can be helpful,” she adds. “Sometimes we‟re able to give quite reassuring information. Sometimes we analyse a family history and we can determine there likely isn‟t a high risk for hereditary cancer in the family. It‟s also very rewarding to give good news on a genetic testing result. Even in breaking bad news – sometimes we give a genetic test result that‟s difficult, it either confirms a high risk or it may be a result that‟s difficult to interpret. But we do it with compassion and we‟re available to provide all the information and resources they need, and to provide supportive counselling.” One thing genetic counsellors won‟t do is tell people what to do. “We would never tell someone whether or not to have genetic testing,” she says. “We always attempt to give information in a non-directive way and allow people to make their own personal choices with the most information possible. We try to help people cope with the genetic condition or information about their family as best they can without telling them what to do.” Hogg fell into genetic counselling when she was taking her undergraduate degree in biology at Montreal‟s McGill University. A prenatal genetic counsellor, who herself was eight months pregnant, came to speak to one of Hogg‟s classes. “I had never heard of genetic counselling before that,” says Hogg. “I was fascinated and I just thought: „I want to do that.‟ “I always loved biology because I found it fascinating,” she adds. “I was especially interested in genetics and I wanted to work with people. I was quite fortunate to meet a genetic counsellor as that was a pretty rare thing in those days.” Hogg began her career in Vancouver in 1990 after taking her masters‟ degree in genetic counselling from McGill. She‟s worked as a prenatal, neurogenetics and cancer genetic counsellor and loves the variety the job has to offer. “It is very interesting,” she says. “There‟s a lot to learn. There‟s always new information. It doesn‟t get stale, it‟s always changing. “In genetic counselling, it is a real privilege to work with these families because they are sharing a very private part of their lives. It is very rewarding to be able to be part of that.” Story and photo courtesy of the Calgary Health Region.