Oncogenetics service and the Brazilian public health system: the experience of a reference Cancer Hospital

Edenir I Palmero, Henrique C R Galvão, Gabriela C Fernandes, André E de Paula, Junea C Oliveira, Cristiano P Souza, Carlos E Andrade, Luis G C Romagnolo, Sahlua Volc, Maximiliano C Neto, Cristina Sabato, Rebeca Grasel, Edmundo Mauad, Rui M Reis, Rodrigo A D Michelli

The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH). The Oncogenetics Department (OD) of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i) genetic counseling, ii) preventive examinations and iii) genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly) of two visits. In 2014, 614 individuals (371 families) were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system.