What to Expect in a Genetic Counseling Session: A Complete Walkthrough

The most important thing you can do before a genetic counseling session is gather your family health history. The more complete this information is, the more accurately the counselor can assess your risk. Here is what to prepare:

• Cancer diagnoses in your family: Note which relatives have been diagnosed with cancer, the type of cancer, and their age at diagnosis. Include both sides of the family (maternal and paternal) and at least three generations if possible.
• Other relevant diagnoses: Some non-cancer conditions (such as polyps, ovarian cysts, or skin findings) may be relevant to hereditary cancer syndromes.
• Ancestry information: Certain hereditary cancer variants are more common in specific populations. For example, BRCA1 and BRCA2 mutations are more prevalent in individuals of Ashkenazi Jewish descent.
• Previous genetic test results: If you or a family member have already undergone genetic testing, bring the full laboratory report (not just a summary).
• Your questions: Write down anything you want to ask. There are no wrong questions, and the session is designed for your benefit.

If you do not have complete family history, that is okay. The counselor can still provide value with whatever information is available. Incomplete information is better than no information. For more on whether you meet screening criteria, see our hereditary cancer screening guide.

A typical genetic counseling session lasts 30 to 60 minutes. Here is what you can expect:

1. Family history review. The counselor will walk through your family health history in detail, building a pedigree (a visual family tree showing health conditions). They may ask questions about relatives you had not considered, such as distant cousins or deceased family members.

2. Risk assessment. Based on your personal and family history, the counselor will assess your likelihood of carrying a hereditary cancer variant. They may use validated risk models to quantify your probability. This is not a diagnosis — it is an estimate that helps guide testing decisions.

3. Education about genetics. The counselor will explain basic genetic concepts relevant to your situation: how genes work, how variants are inherited, and what different types of test results mean. This education is tailored to your level of understanding — no prior scientific knowledge is required.

4. Discussion of testing options. If genetic testing is appropriate, the counselor will explain what tests are available, what they can and cannot tell you, and the potential outcomes — positive, negative, or VUS. For a walkthrough of what testing involves, see our BRCA testing guide. They will also discuss practical matters such as insurance coverage and out-of-pocket costs.

5. Informed decision-making. The counselor will help you weigh the benefits and limitations of testing, but they will not tell you what to do. The decision to pursue testing is yours. If you have already been tested, the session will focus on interpreting your results and developing a management plan.

6. Emotional support. Genetic counselors are trained to help you process the emotional aspects of risk information. Whether you feel anxious, uncertain, or simply want clarity, the counselor is there to support you.

After your session, you should expect the following:

• Written summary: Your counselor will provide a written summary of the session, including your risk assessment, any test results discussed, and personalized recommendations. Keep this document for your records.
• Testing coordination: If you decide to proceed with genetic testing, the counselor or their team will coordinate the sample collection (typically a blood draw or saliva sample) and send it to the laboratory. Results usually take two to four weeks.
• Results disclosure: When results are available, the counselor will schedule a follow-up session to review and explain the findings. For an overview of what different result types mean, see our guide to understanding genetic test results. This is typically a shorter appointment focused on the implications of your specific result.
• Referrals: Based on your results and risk level, the counselor may refer you to specialists (such as a breast surgeon, oncologist, or gastroenterologist) for enhanced screening or management.
• Family guidance: If your results indicate a hereditary variant, the counselor can help you prepare for conversations with family members about cascade testing.

Genetic counseling can be conducted effectively in person or via telehealth (video call). Both formats cover the same content and provide the same clinical value. Here is how they compare:

• Telehealth advantages: Convenient for individuals in rural areas or with limited access to genetic counseling centers. No travel required. Sessions can be scheduled more flexibly, including evenings or weekends in some cases.
• In-person advantages: Some individuals prefer face-to-face interaction, particularly for emotionally sensitive conversations. Blood draws for testing can be done on-site.
• Sample collection with telehealth: If testing is recommended after a telehealth session, a saliva collection kit can be mailed to your home, or you can visit a local lab for a blood draw. This does not delay the process significantly.

LifeShield offers telehealth genetic counseling sessions as an optional add-on for individuals who want professional guidance in interpreting their risk or results.

If you are not sure what to ask, here are questions that many people find helpful:

1. Based on my family history, how likely is it that I carry a hereditary cancer variant?
2. Which genes would be tested, and what would each result type mean?
3. Will my insurance cover genetic testing?
4. If I test positive, what would my screening plan look like?
5. What are the implications for my children or siblings?
6. If I test negative, does that mean I have no hereditary risk?
7. What happens if I receive a variant of uncertain significance (VUS)?
8. How will my genetic information be kept private?

Your counselor is there to answer your questions thoroughly and without judgment. The session is for you, and there is no such thing as a question that is too basic or too detailed. For a comprehensive overview of the role of genetic counseling in hereditary cancer, see our genetic counseling for cancer pillar guide.