Implementing genetics clinic for hereditary cancer in resource-constrained settings: a narrative review

Hereditary cancer syndromes, driven by pathogenic germline mutations such as those in BRCA1 and BRCA2 and mismatch repair genes, represent a critical but under-addressed frontier in cancer care in low- and middle-income countries (LMICs), including India. Genetic clinics-multidisciplinary platforms offering counselling, testing, and cascade screening-have emerged globally as foundational to precision oncology. However, their implementation in resource-constrained settings remains highly uneven, hindered by infrastructural gaps, socioeconomic barriers, and sociocultural complexities.

This narrative review critically synthesises the implementation landscape of genetics clinic for hereditary cancer care, with India as a contextual case. It offers actionable strategies for scaling equitable genetic services in low-resource settings.

A targeted literature search was conducted, supplemented by policy documents and global guidelines (ASCO, IARC, WHO). Thirty-one empirical studies were reviewed. Studies were selected based on relevance to cancer genetics service delivery in clinical or public health settings, particularly in low-resource environments. A thematic synthesis approach was used to distil evidence across six domains: clinical value, operational frameworks, barriers to access, ethical and cultural challenges, public engagement, and delivery innovations.

Genetics clinic demonstrate significant clinical and preventive impact through risk stratification, targeted therapy, and cascade testing. However, integration into routine care in LMICs is constrained by limited workforce capacity, poor awareness, financial inaccessibility, and weak policy frameworks. Ethical concerns-such as inadequate informed consent and fear of genetic discrimination-compound these barriers. Promising delivery models include tele-genetic counselling, mobile clinics, and decentralised integration into existing oncology services. Effective strategies combine institutional partnerships, legal safeguards, and culturally contextualised communication.

Genetics clinic hold transformative potential for hereditary cancer care in resource-limited settings. Achieving equitable implementation requires a locally adapted, ethically grounded, and policy-integrated approach. Investments in training, infrastructure, public education, and governance must align with community needs to enable sustainable genomic integration in LMIC health systems.