Genomics plays an increasingly important role in how we treat cancer. Genomic analyses can tell us who is at highest risk of developing cancer as well as how to treat someone’s cancer in the most precise and effective way possible. “Targeted drugs for cancer happen in 2 different ways,” says Michael Watson, PhD, founder and executive director of the American College of Medical Genetics and Genomics, Bethesda, Maryland. “Some drugs are molecularly targeted, so knowing the specific tumor genetics allows you to identify the best drug for the tumor. But there is also germline pharmacogenetics — someone can have a gene in their own DNA that alters how they will metabolize various drugs.” Understanding and interpreting these genetic differences factor into an oncologist’s decision regarding the best therapeutic approach to pursue.
But oncologists aren’t always trained in the newest genomic tests and technologies, which change rapidly as science in this area continues to advance at a dizzying pace. They often rely on collaboration with medical geneticists, who may work in the laboratories that run somatic cancer testing as well as serve patients clinically themselves, particularly by treating patients who may have a known genetic risk for cancer, such as disruptions in the BRCA1 or BRCA2 genes. Access to these specialist physicians will be a crucial component of cancer care in the future.
A study led by Dr Watson and the American College of Medical Genetics and Genomics addressed the question of whether there will be sufficient numbers of qualified medical geneticists to meet the population’s needs for genetic health care in the future.1 Their conclusion was that thus far, there is a shortage of these experts.
The authors queried 924 genetics professionals and related providers to generate a picture of the current situation in genetics practice as well as to assess current workforce needs. They discovered that compared to previous studies, the wait times to see a medical geneticist and the physicians’ average new patient caseloads had increased. Meanwhile, the number of qualified clinical medical geneticists in practice has not increased. The study found that there were over 100 geneticist and 200 genetic counselor job vacancies. Despite the challenges of accessing geneticists’ care in rural areas, fewer than 18 percent of those surveyed said they used telemedicine.
Watson says they have been trying to increase the pipeline of medical students interested in going into genetics, but one factor holding them back has been that salaries have tracked more along the lines of pediatrics than other more lucrative specialties. “Nothing drives salary improvements like demand,” he says. “Things are starting to improve on that front, which may attract more students.”
Why else are there not enough medical geneticists? Dr Watson says that when the field was first established, geneticists worked mostly with the 7,000 or so rare genetic diseases including chromosomal disorders like Down syndrome, inherited metabolic diseases, and other uncommon diseases that primary care physicians don’t often see in their own practices. The field has grown and changed so quickly in recent years, alongside developments in genomic technologies, that he says it can be hard to project just what the needs are.
“There are more and more [genomics-based] treatments available now, and many adults are being screened for genes that may predispose them to cancer. It’s estimated that once we understand more of the genomic factors that predispose people to disease, we may have 10% or 20% of the population with a genetic change that will moderately increase their risk of disease,” says Watson. “The workforce is quite underpowered for what’s coming.”
- Maiese DR, Keehn A, Lyon M, Flannery D, Watson M; Working Groups of the National Coordinating Center for Seven Regional Genetics Service Collaboratives. Current conditions in medical genetics practice [published online January 28, 2019]. Genet Med. doi: 10.1038/s41436-018-0417-6