The Cancer Genetics Service (CGS) is the clinical branch of the broader Inherited Cancer and Rare Disease Translational Research Programme. In March, 2014, Dr. Joanne Ngeow, returned from subspecialty training in Cancer Genomic Medicine to lead the CGS. The mission of the CGS is to serve 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 the NCCS. This is to ensure that personalised healthcare is based on rigorously researched and validated genetic information that can be incorporated into all healthcare decisions. The CGS serves as a self- and physician-referral-based clinical centre that provides expert genetic risk assessment for a broad array of diseases, education, genetic counselling, targeted gene testing, medical management recommendations, and appropriate multi-specialty referrals. It is unique because the comprehensive clinical practice of medical genetics and genomic medicine is housed under one roof in proximity to the research on which the evidence-based practice of personalised genetic healthcare is performed.
Aligned with the mission of the NCCS and SingHealth, the CGS strives to achieve excellence in all areas of the academic practice of validated genetic medicine and to the rigorous study of emerging areas of genomic medicine practice by:
(Left to right) Zoe Ang, Yanni Chen, Tarryn Shaw, Shao-Tzu Li, Dr. Joanne Ngeow, Eliza Kate Courtney, Nur Diana Binte Ishak
PEOPLECGS is staffed by one staff cancer geneticist (Dr. Joanne Ngeow, 30% full-time equivalent), two visiting clinical consultants (Dr. Min Han Tan and Dr. Peter Ang), 3 full-time certified genetic counsellors (Ms. Eliza Courtney, Ms. Shao Tzu Li, and Ms. Tarryn Shaw) and one part-time genetic counsellor / medical social worker (Ms. Yanni Chen). The clinical cancer genetics service is considered a model in the nation and one of the most comprehensive, as it is integrated between NCCS, SGH, KKH, and CGH for clinical practice, translational research and education.
CLINICAL ACTIVITIESThe CGS carries the full suite of genetic medicine services, ranging from the genetics of adult-onset disorders, such as cancer predisposition syndromes, to rare metabolic disorders. The CGS sees outpatients in the NCCS, and provides inpatient consultations. The CGS receives referral patients from all hospitals, including NUHS, TTSH KTPH, and private doctors. Dr. Ngeow provides cancer genetics services to KK Women and Children’s Hospital (KKWCH) and Changi General Hospital (CGH) in the form of satellite clinics, as well as to clinicians at the Outram campus, working closely with the surgeons, oncologists, and other clinicians. Patient visits to the CGS have risen 10-fold since 2014, and these numbers look to increase in 2018. Common conditions seen at the CGS include Hereditary Breast and Ovarian Cancer Syndrome, Lynch syndrome, Hereditary Paraganglioma and Pheochromocytoma syndrome, Li Fraumeni syndrome and other cancer predisposition syndromes. Patients with a family history or those with young onset cancer are the key reasons for referral. Through efforts to standardise genetic clinical practice and increase efficiency, the CGS has dramatically increased patient access and decreased wait times. Currently, the CGS provides same-day service.
Because genetics informs all subspecialties of clinical practice in the 21st century, the CGS has initiated and built a multidisciplinary platform for clinical care, with each discipline comprising multiple subspecialists from many clinical departments. Since 2014, the following clinics/ workflows have been established for:
In the next 3 years, we have initiated the following to better care for patients with genetic predisposition:
Many of these multidisciplinary clinical efforts are also intertwined with interdisciplinary basic and translational research across the NCCS and throughout SingHealth. In particular, the CGS works closely with the Department of Pathology, SGH (Assoc. Prof. Tony Lim) to develop clinical molecular tests for screening or testing high-risk patients. We will work towards a Centre of Excellence (COE) status for the NCCS in several gene-specific disorders (e.g., PTEN); these COEs are internationally benchmarked and identifies COEs for clinical care and research into these rare disorders. Our goal in the next 3 years is to consolidate what has been built, to improve predictive testing rates in unaffected family members, and to improve carrier’s compliance with surveillance through a prospective hereditary cancer registry.
MAJOR ACHIEVEMENTS SINCE INCEPTION
YOUNG INVESTIGATORDr. Joanne Ngeow is a uniquely trained clinical cancer geneticist having completed fellowships in both Medical Oncology and Cancer Genomic Medicine. She was the Ambrose Monell Cancer Genomic Medicine Fellow (2010–2013) at the Genomic Medicine Institute, Cleveland Clinic, a unique bed and bench fellowship specifically aimed at training the next-generation of cancer researchers in the implementation of cancer genomic medicine for translation in the clinic. She currently heads the Cancer Genetics Service at the NCCS.
Dr. Ngeow was awarded consecutive fellowships: SingHealth Research Foundation Fellowship (2010–2011), NMRC Research Fellowship (2011–2012), and the Ambrose Monell Cancer Genomic Medicine Fellowship (2011–2013). Notably, she was awarded the ASCO Merit Award in 2012 and 2013 for her work in Cowden syndrome. She was awarded the Endocrine Society Early Investigator Award in 2016 for her work in hereditary thyroid cancer. She was awarded the NMRC Transition Award in 2013 and the NMRC Clinician-Scientist Award in 2018. She serves as an editorial board member in Endocrine Related Cancer and contributes actively as a peer reviewer on journals as well as in local and international grant review committees.
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