These proceedings of the March 2007 meeting of the National Cancer Policy Forum of the Institute of Medicine includes papers developed in workshops in response to a decade of genetic testing for certain cancers and recent legislation against genetic discrimination passed by the US Congress. Along with a helpful introduction are several prepared presentations and transcripts of discussions about the state of current technology and practice and, in particular, the ways in which genetic counseling is affecting patient’s decisions about treatment. Along with success stories about patients who have been proactive in seeking preventative treatment are participants’ concerns about decision-making by patients without sufficient medical background or level of detail form caregivers. In one exchange, for example we find that although the debate about the issue is lively, less than one percent of Americans carry a gene predisposing them to cancer.