While only 5 to 10 percent of cancer diagnoses are associated with a hereditary syndrome, many of these syndromes have an alarmingly high lifetime risk of cancer—approaching 80 to 100 percent, with development of disease at younger ages than in the general population. Recent advancements in genetic testing have led to a rapid growth in the knowledge of hereditary cancer syndromes. Options for families facing these risks may include prophylactic surgery, such as mastectomy; earlier cancer screening; and chemoprevention. The key to providing appropriate prevention and medical management is identification of at-risk individuals and access to genetics experts for a thorough assessment. In 2011-2012, St. Luke's Mountain States Tumor Institute (MSTI) implemented wo quality improvement projects for its genetic counseling program: telehealth and chart review.