Sandra Brown is a board-certified, licensed genetic counselor and Genetics Program Manager. She is passionate about precision medicine and access to personalized healthcare. She frequently addresses professional and lay audiences to improve genetic and genomic fluency, collaborates to publish important research, and provides leadership for policy change, information campaigns, and support groups. In addition, she leads community outreach, educational medical rotations, and internship programs in genetic counseling. Ms. Brown is the 2012 recipient of the Ann Walker Award for Excellence in Genetic Counseling and Research and the 2017 recipient of the Making a Difference Award at St. Joseph Hospital for Daring to Change the World for the Better. Ms. Brown is an active member of international, national, state, and regional patient advocate, policy and research networks for inherited cancers. Originally from Chicago, she owned a certified organic farm in Oregon for 15 years, received her undergraduate degree in Molecular Biology and Genetics at the University of Oregon, and her master’s degree in Genetic Counseling at the University of California in Irvine.

Carol Ko is a board-certified, licensed genetic counselor who specializes in inherited cardiovascular disease and cancer genetics. She helped found the Cardiovascular Genetic Clinic at St. Joseph Hospital to increase access to genetic services. Carol is interested in educating healthcare providers and the community we serve about inherited heart disease. Carol is also passionate about working with underserved populations and mentors minority students. Carol earned her master’s degree in Genetic Counseling from the University of Michigan and has published research on the utility of genetic testing and clinical screening for families with hypertrophic cardiomyopathy. Originally from Orange County, she received her undergraduate degree in Microbiology, Immunology, & Molecular Genetics at the University of California, Los Angeles.

Susy Malca is a board-certified, licensed genetic counselor who specializes in cancer genetics. As a native Spanish speaker born in Mexico, Susy is passionate about increasing awareness about, and access to, genetic services within Hispanic communities both in the United States and in Latin America. She founded the Spanish Language Genetic Counselors group which aims to connect Spanish speaking genetic counselors and genetic counselors working with Spanish speaking patients to better understand the needs of the Spanish speaking community, and create resources that will facilitate the genetics process. Susy received her undergraduate degree in Psychology from Rice University in Houston, Texas and her master's degree in Genetic Counseling from the University of California, Irvine.

Chandler Means is a board-certified, licensed genetic counselor who specializes in cancer genetics. Chandler is originally from Southern California and received her bachelor’s degree in Biology from San Diego State University and her master’s degree in Genetic Counseling from Boston University School of Medicine, where she completed and published research on the perceptions of the title “Genetic Counselor.”

Kate Partynski is a board-certified, licensed genetic counselor specializing in cancer genetics. Kate’s interests include tumor genomic testing, genetic screening programs for preventive care and expanding community access to genetic services. She is also passionate about STEM education and mentorship, and performs frequent outreach to schools and universities in Southern California. Prior to joining St. Joseph Hospital, Kate worked in cancer genetics at the University of Southern California and in metabolic genetics at CHOC Children’s Hospital, and brings research and public health experience to her clinical practice. Kate received her undergraduate degree in Biology from the University of San Diego and her master’s degree in Genetic Counseling from the University of Michigan.

Danielle Williams is a board-certified, licensed genetic counselor who specializes in cancer genetics. Danielle has published research surrounding genetic counselor use of somatic testing for Lynch syndrome evaluation. She received her bachelor’s degree in Molecular, Cellular, and Developmental Biology from the University of Colorado at Boulder and her master’s degree in Genetic Counseling from the University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences.

Chelsea Mai is our genetic counseling medical assistant. Chelsea also facilitates the Walk-In Genetic Clinic and prides herself in providing compassionate and quality care. Having worked in healthcare for over 12 years, Chelsea has a wealth of valuable skills and knowledge to assist our patients and genetic counselors. Chelsea also facilitates the Walk-In Genetics Clinic and prides herself in providing compassionate and quality care. She obtained her bachelor’s degree in Health Science from California State University, Fullerton and completed the Genetic Assistant Training Program through Johns Hopkins School of Medicine.

David Margileth, MD, is a medical oncologist and has been the Genetics Program medical director for over 15 years. Dr. Margileth strongly believes in the role of genetic counselors as integral members of the patient centered healthcare team, who support physicians in providing the very best in personalized medical management and help individuals to reach their full health potential through accurate risk assessment, risk reduction, treatment planning, and research.

To schedule a Genetic Counseling appointment at St. Joseph Hospital Orange, please call 714-734-6229.

To schedule at our Mission Hospital location, please call 949-573-9292.

The Cancer Genetics Program at St. Joseph Hospital helps patients and families to better understand and manage their disease risks. While our focus is hereditary cancer and inherited cardiovascular disease, our genetic counselors are qualified genetics professionals for all types of inherited risks and are prepared to discuss the risk of other familial conditions including adult neurological diseases. Genetics is a dynamic and quickly evolving field that supports individualized wellness and prevention. At the leading edge of precision medicine, our genetic counselors provide personalized management recommendations that shift the focus from fear to empowerment. 

An initial genetic consultation typically takes an hour. During the consultation, the genetic counselor will review your personal medical history and construct a three to four generation family tree. The genetic counselor will use this information to create a tailored risk assessment and will have a comprehensive discussion with you regarding: 

• Likelihood that you or your relatives may have inherited a genetic syndrome.
• Your risk of developing cancer or heart disease based on your personal and family history.
• Your risk of developing a second primary cancer and your relatives’ risks of developing cancer.
• Options of genetic testing and identification of the most informative individual/s to test within the family. If you elect to proceed with genetic testing, a blood or salvia sample will be taken during your initial consultation.

• Comprehensive genetic counseling and genetic risk assessment
• An explanation of inherited syndromes and familial disease risk
• Selection and interpretation of appropriate genetic testing when clinically indicated
• Personalized risk management and prevention plan
• Discussion of updated national guidelines and management options
• Family communication, coping, psychological and social support
• Additional risk estimates and recommendations for close family members
• Detailed consultation report

A physician referral is required for all services. A brief telephone interview is completed at the time of scheduling to obtain initial personal and family history, and to answer questions about our genetic counseling services. All new patients are sent a detailed personal and family history questionnaire to complete in preparation for their consultation.

To schedule an appointment call: 714-734-6229 (phone) 

To fax records or a physician referral: 714-734-6218 (fax)

Most appointments are provided onsite at our clinics; however, virtual telegenetics appointments with a licensed genetic counselor are also available. For more information please call 714-734-6229.

Most people undergoing genetic testing will benefit from a formal pre-test consultation with a genetic counselor. However, for some, especially patients with a cancer diagnosis, a quick stop at our walk-in clinics to receive information and provide a saliva sample, is a convenient alternative that allows genetic counselor oversight and an opportunity for a formal post-test consultation.

Any person who is concerned about their personal and/or family history of cancer may benefit from genetic counseling, consideration of genetic testing and receiving a genetic risk assessment.

Our cancer genetics services are beneficial for individuals who have a personal and/or family history that include:

• Cancer (especially breast, colon, or uterine) occurring at an unusual age, typically before age 50.
• Ovarian, pancreatic, or metastatic or aggressive prostate cancer occurring at any age.
• Three or more family members with the same type or related types of cancer. A combination of the same type or related types of cancer occurring in the family. For example, breast, uterine, ovarian, pancreas, prostate, melanoma, colon or other gastrointestinal cancers.
• A rare or unusual type of cancer (Ex: medullary thyroid cancer, pheochromocytoma/paraganglioma, childhood sarcoma)
• More than one type of cancer occurring in the same person that are separate cancers, not metastatic cancer spreading to other parts of the body. (Ex: breast cancer in both breasts, especially if the first occurred before age 65)
• A current lifetime history of 10+ cumulative colon polyps
• Breast cancer diagnosed in an individual of Ashkenazi Jewish ancestry

Any person who is concerned about their personal and/or family history of heart disease may benefit from genetic counseling, consideration of genetic testing and receiving a genetic risk assessment. Our cardiovascular genetics services may be particularly beneficial for individuals who have a personal and/or family history that include:

• Cardiomyopathies: hypertrophic (HCM), dilated (DCM), arrhythmogenic right ventricular dysplasia (ARVC), left ventricular non-compaction (LVNC), familial ATTR amyloidosis
• Arrhythmias: Brugada syndrome, Long QT syndrome, CPVT
• Aortic disease: Marfan syndrome and related aortic disorders, familial hyperlipidemia
• Aortic aneurysm and/or dissection prior to age 50
• Heart attack or coronary artery disease prior to age 50 or in multiple family members
• Unexplained sudden cardiac arrest or death

If a patient elects to pursue genetic testing during their genetic counseling appointment, the genetic counselor and patient will discuss the best test selection including the number and types of genes to be tested. Genetic testing is performed by obtaining a DNA sample (either a small blood or saliva sample), which is sent to a genetic laboratory. The genetics laboratory examines a specified set of genes to look for any "errors" or mutations that cause genes to fail to work properly. The positive identification of this type of gene mutation indicates that a patient is at increased risk of developing certain types of cancers (or other health conditions). In addition, his or her family members may have also inherited the same gene mutation and have an increased risk of developing disease. Fasting is not required for a DNA sample collection. If a saliva sample is recommended, do not eat or drink 30 minutes prior to sample collection.

Genetic test results are typically received within about 2-3 weeks. Once results are available, the genetic counselor will call the patient to review the results and offer a post-test consultation (approximately ½ hour), when appropriate. During the results phone call and/or post-test visit, the genetic test results are reviewed, and individualized screening and prevention recommendations are provided to the patient and family members.

Our genetics counselors explore local, regional, and national studies to identify meaningful genetic research opportunities that may benefit our patients and their families. Research participation is completely voluntary and is typically offered when specific personal and/or family history meets study criteria and therefore provides the most meaningful participation.

Genetic counseling consultation reports and genetic test results are provided to the patient, referring physician and to any additional patient-requested physicians or relatives. All personal and family information and genetic test results are confidential and are not released without the patient's prior written or verbal consent.

Some patients have expressed concerns that insurance companies may use genetic information to discriminate against them. There are federal and state laws that provide protection against genetic discrimination and there are no documented cases of genetic discrimination following genetic counseling or testing for disease risk. The Genetic Information Nondiscrimination Act (GINA) of 2008 is a federal law that protects people from health insurance eligibility and cost discrimination as well as protects people from employment discrimination. Our genetic counselors can provide more information about this during the consultation.

To schedule a Genetic Counseling appointment at St. Joseph Hospital Orange, please call 714-734-6229.

To schedule at our Mission Hospital location, please call 949-573-9292.

Genetic testing may help to rule out an inherited syndrome, provide an explanation for the occurrence of cancer or heart disease in you or in your family and predict elevated risk of developing additional disease. For individuals with a current cancer diagnosis, genetic testing can provide valuable information to your treating physicians in developing the best treatment plan.

Genetic counseling is a process of receiving risk estimates, accurate understanding, management planning and empowerment for individuals and families who are concerned about their risks. It involves meeting with a licensed certified genetic counselor to review your personal and family history, to accurately interpret genetic test results, and to receive compassionate support. Genetic counselors provide personalized recommendations for screening, prevention, and risk reduction.

Genetic testing and genetic counseling testing results can provide management recommendations to help treat and prevent disease and can be used to more accurately advise family members.

Yes, the vast majority of patients have insurance coverage for genetic testing and genetic counseling testing. Our patient account specialists verify coverage prior to the consultation. Individuals may also check eligibility and co-pay information by calling their insurance provider.

Genetic testing is billed by the third-party genetic testing laboratory directly. For most, the cost of genetic testing does not exceed $250. If the cost of the test is a barrier to you, your genetic counselor can discuss laboratory patient assistance programs and help you apply for them.

Inherited cancer syndromes are typically due to inherited “errors” or mutations within specific genes that normally function to prevent cancer. These inherited mutations cause a loss of normal gene function and increased risks of developing certain types of cancer. About 5-10% of individuals have a cancer caused by an inherited cancer syndrome.

Hereditary cardiac conditions are typically due to inherited “errors” or mutations within specific genes that disrupt the normal growth or function of the heart and other parts of the circulatory system. These inherited mutations can cause increased risk for progressive heart disease, especially at younger ages, or even cause dangerous cardiac events and lead to sudden death. About 1 in 250 individuals have inherited heart disease.

Our genetic counselors are qualified genetics professionals for all types of inherited risks, and are prepared to discuss the risk of developing other disorders of familial concern, including hematologic and adult neurologic syndromes. They can also help interpret direct-to-consumer tests and provide clarity on the implications of results for you and your family members. See Genetic Services for more information.

On average, genetic test results are available within 2-3 weeks.

• Positive: A harmful mutation identified that may increase risk of developing certain conditions.
• Negative: No mutation identified.
• Variant of Unknown Significance: Genetic alteration identified, but our understanding of it is limited at this time.

Genetic testing is just one tool that genetic counselors use to provide you with the very best in personalized medicine that genetic testing alone cannot provide. Genetic counselors are genetic experts and remain up to date on the constantly changing field of genetics. They are trained to tailor, translate, and communicate complex genetic information into practical, accurate, and understandable decision-making information that you, your relatives, and your healthcare team can use to provide the best in individualized healthcare management. They help to insure the very best outcomes for you and your relatives.

Continued contact with genetic professionals is advised for many individuals who have undergone genetic counseling and/or genetic testing. Over time, new technologies are developed, new genes become available for testing, insurance criteria for testing may change making testing more accessible and management updates for mutation carriers become available. Additionally, family histories change over time making reassessment of the family history beneficial. We recommend having genetic counseling if you have significant family history and you previously had genetic testing without seeing a genetic counselor. In addition, we recommend contacting your genetic counselor every few years. 

• If you previously had genetic counseling but genetic testing was not done: If you underwent genetic counseling without genetic testing, you may benefit from meeting with a genetic counselor again. The criteria for genetic testing have expanded, insurance companies are much more likely to cover genetic testing, and the cost of genetic testing has decreased significantly. A genetic counselor can help you review your options, order the appropriate test, and review your results and their implications.
• If you previously had genetic testing which identified a pathogenic mutation (positive results): With time, more information becomes available regarding specific hereditary cancer syndromes. If your previous genetic testing identified a mutation, it is important to keep in touch with your genetic counselor periodically to review the most up to date information regarding cancer risks and management guidelines and to make sure that your previous genetic testing was comprehensive.
• If you previously had genetic testing which did not identify any mutations (negative results): With time, more hereditary cancer genes are being identified, comprehensive genetic testing is becoming more accessible, and genetic technologies are advancing. If your previous genetic testing was uninformative because it did not identify any mutations, updated genetic testing may be indicated.
• If you previously had genetic testing which identified a variant of unknown or uncertain significance (VUS): With time, more information becomes available and variants of uncertain significance may get reclassified. A genetic counselor can review the current literature and data regarding your VUS, discuss what is known, what steps may be taken to reclassify it, and recommend further genetic testing if indicated.

Genetic testing for tumor molecular profiling (somatic) is different than genetic testing for inherited cancer risk (germline). Genetic testing of cancer tissue helps to characterize the tumor while genetic testing for inherited risk helps to estimate and reduce familial cancer risk. A genetic counselor can review tumor genetic test results in conjunction with your personal and family history to help you understand your results and your risk for an inherited cancer susceptibility syndrome.

Some DTC companies, such as 23andMe and Ancestry, offer "health" tests. These tests are not diagnostic and should not be used to make medical decisions. If you previously had DTC genetic testing and were told you had an increased risk of developing a certain condition, such as cancer, a genetic counselor can review these results with you and, if indicated, order diagnostic confirmatory testing.

In addition, DTC testing is very limited, looking at a few mutations while clinical genetic testing fully analyzes those and other relevant genes. Therefore, "normal" DTC testing results do not actually rule out hereditary cancer syndromes or other hereditary risks.

Federal and state laws provide protection against genetic discrimination. The Genetic Information Nondiscrimination Act (GINA) of 2008 is a federal law that protects people from health insurance eligibility discrimination including additional fees or costs and also protects from employment discrimination. GINA does not protect against all forms of genetic discrimination and does not specify protection from other insurance discrimination such as life, disability, and long-term care. Learn more about GINA. Our genetic counselors can discuss any concerns you may have regarding genetic testing and privacy.

If you have other questions about any of our services, please call 714-734-6229. 

To schedule a Genetic Counseling appointment at St. Joseph Hospital Orange, please call 714-734-6229.

To schedule at our Mission Hospital location, please call 949-573-9492.