Genetic counseling and HNPCC.

Cancer control objectives in HNPCC can be realized when patients who are at increased genetic risk receive intensive education about the natural history, as well as the surveillance and management recommendations that this diagnosis entails. It is only when family members are sufficiently informed about all of the pertinent clinical and genetic aspects of HNPCC that they can make the best possible decisions about those cancer control strategies which will likely impact heavily upon their lives. The sum total of these ramifications come under the rubric of genetic counseling. Our experience indicates that genetic counseling must embody all of the trust and confidence which is inherent in a physician/patient relationship. This involves the understanding that one is dealing with an ego-involved patient who may be very anxious and apprehensive about his or her cancer risk, as well as that of siblings and progeny. We have described the importance of psychodynamic factors which impact upon the genetic counseling process and often compel the counselor to assume the role of a psychotherapist.