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Genetic counseling services at the Center for Cancer Care

Using personal and family history to assess risk. 

Cancer genetic counseling is the process of collecting your detailed personal and family history, assessing your personal risk, and discussing your genetic testing options. Genetic tests are tests on blood and other tissue used to identify genetic disorders.

Genetic counseling and testing services are offered to individuals and families as part of our comprehensive model of patient-centered care in collaboration with the Smilow Cancer Genetics & Prevention Program. Services are provided by a team of graduate-trained counselors who are certified by the American Board of Genetic Counseling.

Hereditary Services

The Center for Cancer Care at Griffin Hospital offers genetic counseling and testing services to anyone with an increased risk of developing hereditary forms of cancer, including breast and ovarian (BRCA), colorectal (HNPCC, FAP), and others (Li-Fraumeni, Cowden, etc.). These services can help you identify if you are at increased risk genetically of developing cancer, enabling you and your physician to make important informed medical decisions about screening and prevention to reduce your risk.

Non-Hereditary Services

The Hewitt Center for Breast Wellness has launched a high-risk breast cancer program that includes the state-of-the-art BREVAGen™predictive risk test. BREVAGen assesses a woman's unique risk of developing non-familial or sporadic breast cancer with a simple, in-office oral swab test.

BREVAGen uses Clinical Risk and Genetic Markers to assess individual risk of developing sporadic breast cancer. Once the risk level is known, the doctor will help develop a plan for monitoring the patient's breast health and recommend life changes that may minimize the chances of developing breast cancer.

When to Consider Genetic Testing

Individuals who have a personal and/or family history that includes any of the following may benefit from cancer genetic counseling:
  • Multiple relatives on the same side of the family with the same cancer or related cancers e.g. breast/ovarian/pancreatic/melanoma; colon/uterine/ovarian
  • Cancer at unusually early ages e.g. breast cancer younger than 45 years old or colon cancer younger than age 50
  • More than one diagnosis of cancer in the same individual e.g. breast and ovarian cancer, or colon and uterine cancer in one person
  • Rare cancers e.g. male breast cancer, medullary thyroid cancer
  • A family history of a known altered cancer-predisposing gene

Consider genetic counseling if you have a personal and/or family history of:

Breast or Ovarian Cancer

  • Breast cancer diagnosed before age 45
  • Multiple cases of breast cancer on the same side of the family
  • Ovarian cancer in a family with breast cancer
  • Male breast cancer
  • Multiple cases of pancreatic cancer on the same side of the family
  • The combination of breast, ovarian, and/or pancreatic cancer on the same side of the family or in a single individual
  • Jewish ancestry in combination with any of the above
  • Jewish ancestry and even one case of breast or ovarian cancer (even in the absence of additional family history)
  • Medullary breast cancer and triple negative breast cancer are over-represented in women with hereditary breast and ovarian cancer

Colon Cancer

  • Colon cancer diagnosed before age 50
  • Multiple cases of colon cancer on the same side of the family
  • The combination of colon, uterine, ovarian, urinary tract, and/or other gastrointestinal cancers on the same side of the family
  • A single individual with colon and uterine cancer, more than one separate colon cancer diagnosis, or colon and ovarian cancer
  • Even one sebaceous carcinoma
  • A colon cancer in which screening tests (called microsatellite instability (MSI) and/or immunohistochemistry (IHC)) have indicated an increased risk for hereditary colon cancer
  • Multiple colon polyps (adenomatous, hamartomatous, or juvenile)


Our program does not require a referral, but your insurer may. Many insurance companies cover part, if not all, of the counseling and testing charges associated these services. Please check with your health insurance provider for specific information about your coverage.


Genetic Testing FAQs

Genetic counseling is a process that includes collecting a detailed personal and family history, a risk assessment, and a discussion of genetic testing options. We will discuss the risks, benefits, and limitations of the available testing options and personalized cancer screening and risk reduction recommendations during the counseling sessions. Our program consists of 2-3 genetic counseling appointments, lasting an hour each, that go along with the option of testing. In some cases (e.g. when the mutation in the family is known, when testing is needed for an urgent medical issue, such as breast cancer surgical decision-making), the content of the first two visits may be combined.

At the initial appointment, we will take a detailed family history and personal medical history that includes information on all family members with our without a cancer diagnosis. The information collected includes ages of family members, genetic diseases, birth defects, and ethnic background, as well as ages at death, primary sites of cancer, and ages of cancer onset in those family members who have experienced cancer.

The second appointment includes a detailed discussion of:

  • The likelihood that the cancers in a family are hereditary
  • Which genetic test, if any, would be most appropriate
  • The risks, benefits, and limitations of genetic testing
  • Available screening and risk reduction options
  • A blood draw, if testing is chosen

During the third appointment -- for those who decide to have testing – individuals receive their test results in person. This appointment includes a detailed discussion of the meaning of the results for the individual and other family members and options/recommendations for future cancer detection and risk reduction based on results.

Following the last appointment, we will send a detailed summary of the information discussed at all the appointments. We can also send a copy of the letter to your referring healthcare provider and to any other healthcare providers whom you designate.

Individuals who have a personal and/or family history that includes risk factors for hereditary cancers may benefit from our program. These risk factors include multiple relatives on the same side of the family with the same cancer or related cancers, cancer at unusually early ages, more than one diagnosis of cancer in the same individual, rare cancers, or a family history of a known altered cancer-predisposing gene.

Individuals with a personal and/or family history of any of the following risk factors may benefit from a referral to the cancer genetic counseling program:

  • Early onset breast cancer (diagnosed before age 45)
  • Early-onset colon, uterine, pancreatic, diffuse gastric, or renal cancer (diagnosed before age 50)
  • Ovarian/fallopian tube cancer at any age
  • Male breast cancer at any age
  • Medullary thyroid cancer or adrenocortical carcinoma at any age
  • Cancers on the same side of the family known to be caused by a single gene mutation (e.g. breast/ovarian/pancreatic/melanoma; colon/uterine/ovarian)
  • Jewish ancestry in combination with a personal or family history of breast, ovarian, or pancreatic cancer at any age
  • Multiple primary cancers in one individual (e.g. bilateral breast cancer; breast/ovarian; colon/uterine; uterine/renal/thyroid or multiple primary melanomas)
  • Individuals with multiple and/or early-onset gastrointestinal polyps (multiple polypsis, >15 GI polyps, or >5 harmartomatous or juvenile polyps
  • Rare or unusual tumors or physical findings (e.g. sebaceous carcinoma/adenoma)
  • Any Lynch syndrome-related cancer/tumor that is MSI or IHC abnormal
  • Known genetic mutation (e.g. BRCA, MLH1, RET, p16)

We do not offer testing alone. Counseling is an integral part of the testing process and is essential to ensure that the correct test is ordered and for accurate result interpretation and medical management.

Studies have shown a high rate of genetic test result misinterpretation among providers who do not specialize in this area. Due to the complexities of the cancer genetic counseling and testing process (including which test to order and interpreting the results correctly), we have structured around program around cancer genetics specialists, who are expert in this area.

This information will help to estimate a person’s true risks of developing cancer, and to develop a personalized plan for surveillance and management based on those risks. It can also be very useful to the entire family. We discuss these issues, in depth, in the counseling sessions.

Most insurance companies cover part, if not all, of the counseling charges associated with our program. Check your insurance policy to see if you generally require a referral from your primary care physician.

After your first session, we will determine which genetic test, if any, would be most appropriate and whom in the family (ideally) should be tested first. We will discuss the cost of that testing (range between $385-$3,200) and, at your request, will navigate the insurance authorization process for you. Letters of medical necessity are sometimes required and we will write such a letter for you after your first session, if needed.

It does not appear that billing health insurance companies for cancer genetic counseling or testing represents a major risk. However, future coverage for life and disability insurance may be affected by such services, particularly if you are not a cancer survivor. For more information, please see Insurance Concerns: Update on Genetic Discrimination.

Cancer genetic counseling and testing are now offered as a clinical service. However, if you are seen by our program, we will invite you to participate in our data repository, which allows us to share deidentified data with current and future studies to advance research in this area. In addition, depending upon your personal and/or family history, you may be invited to participate in other research studies that are available through our program.

The more information you give us, the more accurate your counseling will be. We can collect some of the following information after your first session; however, it would be ideal for you to collect it and bring it to your first appointment.

  • If you have had cancer, please bring us a copy of your pathology reports or have them faxed to our program at 203.764.8401 before your first appointment.
  • We will be asking you questions about your family members, particularly your brothers, sisters, parents, children, grandparents, aunts, uncles, nieces, nephews and cousins. If any of them have had cancer, please find out the primary site of the cancer and their age at diagnosis. Pathology reports are very helpful.
  • If any of your family members have had genetic testing, please bring us a copy of the actual test results.

Our program does not require a referral, but your insurance may require one. Please check with your particular carrier and policy on this issue.

Appointments are typically scheduled one-to-two months ahead of time. Exceptions are made for medical emergencies.

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