The Hereditary Breast and Ovarian Cancer (HBOC) Clinic provides multi-disciplinary follow-up management for women who have been identified with a mutation in a cancer predisposition gene (ex. BRCA1, BRCA2, etc.). Women with a mutation in one of these genes, have a high risk of various cancers (ex. breast, ovarian, etc.). In this clinic, we follow women throughout their lives to ensure that they have access to enhanced cancer screening, cancer prevention, follow-up care, and psychosocial services.
This figure shows some of the specialties that women may access through the HBOC Clinic to manage their risk of cancer, depending on their gene mutation and the cancer risks associated with that gene (ex. BRCA2 may see dermatology for increased risk of melanoma).
Once a patient has been identified with a mutation in a cancer predisposition gene, they can be referred by their health care provider to the HBOC clinic. The nurse practitioner will do an intake assessment with the patient to confirm their genetic mutation and go over the current healthcare needs of the patient. Our clinic follows the guidelines of the National Comprehensive Cancer Network (NCCN), which are specific to the type of gene mutation identified.
Patients with mutations in the following genes are followed in the HBOC clinic:
ATM, BARD1, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, MSH2, MLH1, MSH6, PMS2, EPCAM, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11, TP53.
All women who are referred to the clinic will receive appropriate referrals to the specialties they require based on the age of the patient, the personal preferences of the patient, and the gene specific management recommendations. Patients will connect with the HBOC clinic nurse practitioner on an annual basis, or as needed.
If you wish to access the Ontario Health Insurance Plan (OHIP) funded HBOC Clinic, you can contact your care provider (physician, nurse practitioner, genetic counselor) and request that they submit a referral to the Women’s College Hospital Breast Centre – HBOC Clinic.
Once your referral has been received and it has been determined that you are eligible for the HBOC Clinic, you will be sent an Intake Assessment Form. This is filled out prior to your first appointment.
Your Intake Assessment Form will be reviewed and a virtual appointment will be booked with the HBOC Clinic nurse practitioner. Following this, you will be scheduled for additional HBOC Clinic appointments with a variety of care providers/specialists based on your individual needs and goals. Some of these appointments may be in-person and some may be virtual. You may see one or several providers depending on your individual plan of care. These providers may include a: plastic surgeon, general surgeon, general practitioner in oncology, gynecologist, social worker, genetic counsellor, peer support worker and/or genetic counselor.
Frequently Asked Questions
Please click the following link to see options for genetic testing at Women’s College Hospital.
In most cases, you will see providers at Women’s College Hospital (either in-person or with virtual appointments). If you do not live within the Greater Toronto Area, there may be opportunities for virtual appointments for some specialties, or you may be able to access services in your own area (including breast screening).
This information can be found on the genetic testing documents that your genetics provider would have shared with you or your primary care provider. If you do not have access to these documents, please contact the clinic where you had your genetic testing done to obtain a copy of your genetic test results.
Currently, the clinic focusses on individuals who were born female. There is a clinic at Sunnybrook Health Sciences Centre that follows men.
No. Anyone in Ontario with a valid health card can access services at the HBOC clinic.
We want to make your follow-up management as convenient as possible. If you want to continue to have your screening done close to home, this can be accommodated. Some women may only wish to use this clinic to access one specialty, like breast surgery for risk-reducing mastectomy. When you talk to the nurse practitioner, he/she will go over your preferences and will develop a management plan specifically for you.
Any woman who has been identified with a mutation in a breast/ovarian cancer predisposition gene is eligible to access the clinic. Typically, genetic testing is done after the age of 18 years.
If you would like to refer your patient to the HBOC Clinic at Women’s College Hospital, please find the form below. Please indicate on the referral that you would like your patient seen in the “HBOC Clinic” for multidisciplinary cancer genetics management.
If your patient has not had genetic testing and you would like to refer them to Women’s College Hospital for testing, please find the form below.
Resources are available for both patients and health care professionals. The following are websites and links that may provide answers to many of your questions. Please note, some of the links on these pages may go to external websites.
- BRCA Women’s College Cancer Genetics Newsletter
- What You Need To Know: Preventative Surgery to Remove your Fallopian Tubes and Ovaries
- Understanding Skin-sparing and Nipple-sparing Mastectomies
- Montreal Conference
- Canadian Cancer Society
If you have any questions, please contact the WCH Breast Centre at 416-323-6225 and you will be directed appropriately. Additional contact information can be found here.