«We have to take away the idea of being guilty for your genes»

The «Introductory Course in Genetic Counseling in Oncology» will be held on 2.10.2026 in Lausanne under the auspices of the Swiss Cancer Institute’s CPTC Network. It is intended for physicians from various specialties, nurses, and other healthcare professionals involved in genetic counseling in oncology. The chair of the event, Dr.med. Sheila Unger, gave insights into the course and about genetic testing and counseling in Switzerland.

What can you tell us about the 19^th Introductory Course in Genetic Counseling in Oncology 2026?

S. Unger: The Genetic Counseling in Oncology course is specifically designed to provide physicians working in Switzerland with sufficient information and confidence to order genetic testing for their patients who are either affected by cancer or who have a family history of cancer. Participation in this course is one of the basic requirements for joining the «Network for Cancer Predisposition Testing and Counseling», the CPTC Network. Membership in this network is one of the criteria for ordering genetic testing in this field. The course is traditionally attended by gynecologists and oncologists, however, it is open to health care professionals of all fields who may be seeing this type of patients, from family doctors to pathologists.

The course has been held 19 times now, and the design has been updated to reflect modern practices and evolving genetic technologies and knowledge. It covers the basics of molecular interpretation, explains how genetic testing can be used to modify your patient’s treatment, how to inform and educate patients, gives insights into which pathological examinations can be useful, how to manage getting insurance reimbursement, and how to use various algorithms and risk prediction tools such as Can Risk.

We are very lucky to have leading Swiss experts teaching in the course as well as having international experts and speakers present. We will be hearing a lecture from Prof. Dr. med. Steven Narod, who is one of the world-leading experts in BRCA1 and BRCA2. He will be addressing appropriate imaging for genetic carriers of these conditions.

What else is required to join the CPTC Network?

S. Unger: The CPTC Network is a branch of the Swiss Cancer Institute that was established specifically to reflect the necessity for high-quality counseling and testing for people with a suspicion of a hereditary predisposition for cancer.

The section of the «Krankenpflege-Leistungsverordnung» dealing with prevention mentions specifically that geneticists and members of the CPTC are those who can order genetic testing. In order to become a member of the CPTC Network, having a course in genetic counseling is a prerequisite and this course, which is done under the auspices of the CPTC, is of course recognized for becoming a member.

You also need to provide proof that you are in steady cooperation with a geneticist within Switzerland and you need to regularly attend the CPTC meetings.

How has genetic testing and counseling changed in the past years?

S. Unger: Genetic testing has significantly changed with the advent of high-throughput technology. When we started this course many years ago, we were still talking about Sanger sequencing of BRCA1 and BRCA2. The CPTC was one of the early adopters of panel testing.

We have evolved together with the available technology. Insights into new technology and consequences for our work and patients will be presented in the course during the molecular talk by Dr. med. Benno Röthlisberger.

The evolution of genetic testing has also changed the field of pathology since nowadays many tumors are sequenced individually. Now, we incorporate into the course how to use molecular testing and pathology to inform testing in the germline. For the third time we also include the evaluation of how to use the prediction algorithm of Can Risk to better personalize your estimate of a patient’s risk who is either a carrier or a non-carrier of a pathogenic variant.

We have moved with the times and offer more information on how to personalize the risk estimation, how to use new genetic technologies and how to use the information that comes to us via pathology to inform the genetic testing.

Is genetic counseling part of the medical curriculum in Switzerland?

S. Unger: Genetic counseling is not covered in med school in any country that I’m aware of. It touches on topics that are not addressed in a typical physician consultation. These topics heavily involve statistic and probabilistic thinking and include questions such as: What are the implications of this genetic test result for the patient’s family? If they have a mutation, what will this mean for their future cancer risk? How will they discuss this with their partner, their children, et cetera? The last question has a psychosocial aspect in terms of how people will integrate carrying a genetic mutation into the way they feel about themselves. Genetic testing always includes dealing with uncertainties.

How do you deal with the consequences for people who are being tested?

S. Unger: With the allowance to do this kind of testing comes the responsibility to communicate well with the patients in an empathetic way. The communication of being a carrier for a genetic predisposition for cancer is always easier if there has been good pre-test counseling. And good pre-test counseling includes dealing with concepts such as the idea that we are not responsible for our genomes, which we have inherited from our parents, which they were not responsible for either.

With ideas of self-determination, especially when we’re dealing with things that are in the predictive domain, people ought to know that the doctor will make recommendations, but that it will be their decision at the end what to do with the results. One of the things that can be helpful is to explain that the cancer risk prediction comes with measures that we can take in terms of surveillance or surgery to reduce the risk or to offer early detection, in order to use testing not for increasing nervousness, but to help them live a longer and healthier life.

However, the question of communication is very pertinent as prudence is always key when dealing with pre-symptomatic testing. Imagine the situation, when a healthy person comes to the clinic, and they want to know about their cancer risk: We do not want to cause someone who considers themselves healthy to become someone who considers themselves sick.

In conclusion, we need to provide good pre-test counseling and make sure to cover which prevention strategies will be applicable should something be discovered. Moreover, we have to take away the idea of being guilty for your genes.

Your talk will be about insurance issues. What can you tell us about the topic?

S. Unger: I think every physician working within the Swiss health care system will know that there is always a back and forth between physicians and the «Vertrauensarzt» and that many things are open to interpretation as to what should be covered by the insurance.

My talk at the event will touch on guidelines that are regularly accepted by physicians both in practice and by the Vertrauensarzt and I will give some tips on how to construct a good KOGU, a «Kostengutsprache», so that it will meet the requirements of the Vertrauensarzt. Due to the reimbursement situation in Switzerland genetic testing is covered by the base insurance and the Vertrauensarzt will need to know that not only there is a testing based on the personal or family history, but that there will also be outcomes from the testing, and that these will vary by situation. There are some situations that are very clear and should be easily accepted, others may fall into more of a gray zone.

What are you most looking forward to in the event?

S. Unger: What I always look forward to in the event is to meet colleagues, young or old, who are interested in this domain, because I think it is a very important one and we need all of the help that we can get in order to make sure that every person in Switzerland who would benefit from testing is getting it in a timely manner. Every year I am happy and reassured to see the growing number of people who are interested in this field and who are willing to give their time and energy to move the field forward and to help patients. Meeting new colleagues is the best thing for me about the course.

Do you have a closing statement?

S. Unger: This course is both scientifically and administratively interesting, and I hope that it will bring new colleagues into the field and new CPTC members into the network.