Genetic Counseling Field Notes

My dear friend and co-worker, Julie Mak and I worked on this article which will be published in the next UCSF Cancer Risk Program newsletter. This is actually the article I was working on when I met the waiter from the "musical cafes" blog entry.


Clinical Meeting with the ProCanHe Team:
Dr. Carlos Vaccaro, Nicola Stewart, Dra Denise Cytryn, Alejandra Ferro, Paola Bertorelli, Jose (Apellido)

Field Notes: Exploring Hereditary Cancer in the Land of Steaks, Malbec and Tango

Genetic Counselor Nicola Stewart recently commemorated five and a half years of service with the Cancer Risk Program by taking a sabbatical in Buenos Aries, Argentina. Consistent with Nicola’s spirited and adventurous style, she has been busy forming international friendships, learning Spanish, and of course, the Tango.

While you can take the girl out of the Cancer Risk Program, you can’t take the Genetic Counselor out of the girl. In between exploring museums and cafés, Nicola found time to work at the Hospital Italiano in Buenos Aries, where she has been collaborating with Dr. Carlos Vaccaro, MAAC, MSACP, a colorectal surgeon who founded the “ProCanHe,” or Progama de prevención y tratamiento del cáncer hereditario (Program for the Prevention and Treatment of Hereditary Cancer).

Although separated by over 6000 miles, the concerns of patients in Buenos Aries are very similar to those in the San Francisco Bay Area, Nicola found. People in both places share a deep concern about their family members, and they struggle with the decisions they face when they learn they are at increased risk of cancer. The administrative challenges are also very similar. Like the Cancer Risk Program, ProCanHe is exploring ways to reach out to patients and other healthcare providers to spread the word about the work they do.

A major difference Nicola found is the availability of genetic testing. Genetic tests from Argentina need to be sent to the US or Brazil or to be done part of a clinical trial. This limits the options available to healthcare providers and patients. In addition, the economic crisis of 2001 and the devaluation of the peso, make the relative cost of a genetic test (U$S3000) in Argentina insurmountable, in a country where the average salary is U$S10 000.

The experience at the Hospital Italiano, like the rest of Nicola’s journey, has been both rewarding and challenging. In her words, “As genetic counselors, we act as a liaison between the medical community and the patient. We take pride in dealing with the psychosocial aspects of care. Although, given the language barriers, I haven't been able to be as empathetic as I would like to be. I feel I am either over-emphasizing something, or under-emphasizing. We throw around a lot of scientific terms, medical diagnoses and patients have to really think to follow along. In my sessions here, it's the same, although the patient is struggling to just understand me in the regular language, not even the scientific language!”

Besides working with patients directly, Nicola has been training a health educator, Alejandra Ferro, at the hospital to take family histories, recognize patterns of hereditary cancer, and develop new approaches to find families who would benefit from their services.