The future of genetic counselling: an international perspective

The focus of clinical genetics, and thus genetic counselling, is forecast t o expand from the diagnosis and prediction of rare, often untreatable condi tions, to the prediction of common, often treatable or preventable conditio ns'. Whether this evolution is likely to proceed rapidly or at a pace that permits sensible integration of molecular genetic tools is unknown and a so urce of debate(2,3) . It is clear, however, that genetic discoveries will m odify the way in which disease and risk are conceptualized. Here, we predic t how genetic counselling, specifically for more common diseases, might be provided in the decades to come. We envisage an expansion of professional r oles and expertise for many health care providers and highlight the need fo r counselling practices to become more evidence based. Although we support an evidentiary-based approach to the integration of genetic testing into pr actice, genetic advance is unlikely to occur in an orderly and standardized manner within countries, much less among different countries and health ca re systems(4). Geneticists will become increasingly involved in professiona l education and policy-making regarding genetic testing and screening progr ams.