The room – though painted in warm colours and with pale yellow wood furniture – is unbearably cold. “Thank goodness I brought a jacket,” I mumble to myself, silently grumbling at the diligent air conditioning.
“Hello there!” chimes Tarryn as she walks into the room. I’m interviewing Mrs Tarryn Shaw, Genetic Counsellor at the National Cancer Centre Singapore (NCCS). Genetic counselling is, unfortunately, still an emerging field in Singapore and Asia. In Singapore, there are only around 10 genetics counsellors, four of whom are in NCCS! What do genetic counsellors do on a daily basis?
So...What exactly is a Genetic Counsellor?
“I think a more self-explanatory term is a ‘genetic consultant’ – which really gives a better picture of what we do,” adds Tarryn. We start the conversation by addressing a common misconception: Contrary to what the job title might suggest, genetic counsellors are not ‘counsellors’ per se. Particularly in hospitals, most people confuse that term with what medical social workers do.
Genetic counsellors are professionals specifically trained to manage individuals and families who are at risk for genetic conditions. They advise whether genetic testing is appropriate, interpret results and explain the nature and significance of the condition. They also discuss how the condition is inherited and what the associated health and reproductive risks are. Throughout this process, they provide support and help individuals and families adjust to the condition as best they can. A genetic counsellor can work in more than one specialised area and various disciplines of medicine. “We’re specifically trained in both medical genetics and psychology, therefore our role expands far beyond only providing support,” Tarryn explains.
The secret life of a genetic counsellor
I begin to follow Tarryn around, trying to be as inconspicuous as possible. She points out that genetic counsellors don’t have a set routine every day – at least in NCCS, anyway. “The nice thing about what I do is that every new day brings new challenges,” she says, as she takes us along to experience the major parts of her day (and week).
Running the Clinic
My daily routine is to grab a quick cup of coffee if time permits. Clinic starts bright and early at 8.30am. At NCCS, we work with individuals suspected to have a particular hereditary cancer syndrome (which varies from person to person).
We help them determine how best to manage their inherited cancer risk and assess the cancer risk of their family members. Knowing how to best manage this risk could help save lives – prevention is always better than a cure – and this strategy has been proven to save costs for both the patient and organisation. This involves working through the family tree and medical history, to determine if a person or their family’s health history is due to a genetic cause or not. Another misconception is that every patient we see has to go through genetic testing. That’s not true. We only recommend a genetic test if we are suspicious of a genetic condition and if we truly feel that it would benefit the patient and/or their family. As with every medical recommendation, it’s still the patients’ right to decide what’s best for them. Family conferences are also common in our clinical setting. An interesting fact is that genetic testing also helps with treatment decisions for someone with cancer. For example, some drugs respond well with patients with specific genetic changes. The misconception about genetic testing is that it’s ‘unaffordable’. The cost of genetic testing has come down substantially over the years and there are many financial subsidy schemes and ways in which we are able to offer our patients genetic testing even if finances are an issue.
What most people don’t see is what happens before or after the clinic. Our work with a patient doesn’t just stop at the clinic – there’s still plenty that goes on behind the scenes. For example, before clinics, we might be reviewing a patient’s files, working out their family’s history and what this could be related to, or reviewing the results of their genetic test. We see anywhere from 10 to 20 patients per day, so you can imagine how much work goes on behind the scenes!
Besides the clinic and administration, most of us are also involved in research. We are living in an era in which genetic information about ourselves is easily and readily accessible but not very well understood. From what we currently understand, approximately 15% of all cases of cancer are caused by inherited gene mutations, so there’s a pressing need to devise better methods of cancer detection, prevention and treatment. There’s always new discoveries and information especially in the field of medicine or oncology. Sharing of knowledge is so important, arming medical professionals with the latest information. This not only applies to Singapore but the rest of the world too. Apart from reading up on new updates, new clinical trials and new gene discoveries, we occasionally attend local and overseas conferences to share and learn the latest developments in cancer care.
Another fun part of my job is sharing knowledge and educational talks. These go out not only to the public, but medical professionals and medical students too. What’s interesting are the interactions with the next generation of healthcare professionals at polytechnics or universities. Hopefully we can also bring up the awareness of genetic counselling as a career choice and help encourage the next generation of geneticists!
Medicine has changed tremendously in the past years. Patients should take heart that there are teams of people who come from different medical backgrounds, all working together to achieve the best outcomes for each patient. On various days, my colleagues and I attend Tumour Boards in NCCS, KK Women’s & Children’s Hospital and Changi General Hospital (where we also run clinics!). Here, complex cases are discussed with teams of doctors, nurses and other health professionals – experts in each field of cancer treatment – to decide the best possible treatment and management strategies. In our case, I provide genetics expertise during these discussions.
About Mrs Tarryn Shaw
Tarryn Shaw (MSc (Med) Genetic Counselling (UCT, South Africa)) is a genetic counsellor at the Cancer Genetics Service, National Cancer Centre Singapore. Her professional interests include genetic predisposition to hereditary conditions and helping/advocating for people and families with these conditions. Her research interests include culture and its influences on health-related decisions, psychosocial impacts and ethics of practice. Tarryn hails from South Africa and has been working as a genetic counsellor in Singapore since 2017.
About the Cancer Genetics Service
Cancer Genetics Service (CGS) serves as an expert base in the principles and practice of genetic and genomic medicine as a single platform for research, academic clinical practice, and education for NCCS and SingHealth. It provides validated genetic information to support healthcare decisions involved in personalised medicine. The service specialises in the care of people with personal or family histories of cancer, which includes both childhood and adult-onset disorders, such as cancer predisposition syndromes. Occasionally we see other rare genetic conditions outside of the cancer spectrum. The CGS started in 2014 and is headed by Assoc Prof Joanne Ngeow. The clinic is staffed by medical oncologists and genetic counsellors with advanced specialisation in genetics.
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