Bridging the gap: Nationwide genetic counsellor’s survey insights to plan a scalable framework for cancer genetic counselling in India.

e13550 Background: Genetic counselling (GC) is central to precision oncology, guiding appropriate genetic testing for treatment, prevention, and risk stratification. India’s rising cancer burden and expanding genomic testing far outpace the capacity of its 316 board-certified genetic counsellors (BGCI, India). GC practice is largely limited to germline risk assessment for hereditary cancer syndromes with minimal integration into somatic oncology care and multidisciplinary tumor boards. To date, oncology readiness and scalability of India’s GC workforce have not been systematically evaluated. Methods: A cross-sectional, anonymous nationwide online survey was conducted via Google Forms (Sept–Oct 2025). The questionnaire assessed practice setting, training, experience, oncology-specific workload, tumor board access, perceived value of cancer GC, practice barriers and openness to tele-genetics or AI-enabled tools. Data were analyzed using descriptive statistics. Results: 147/316 (46.5%) genetic counsellors responded, based in diagnostic laboratories 50/147 (34%), hospitals/clinics non-oncology 33/147 (22.4%) and only oncology 33/147 (22.4%). Genetic Counsellors held a relevant MSc degree 41/147 (27.9%), PhD 41/147 (27.9%) and Diploma 40/147 (27.2%) along with BGCI certification. 56/147 (38.1%) have more than 5 years’ experience. 26/147 (17.7%) reported more than half of their caseload was oncology-related, GC was predominantly germline-focused with breast/ovarian 119/147 (81%) and colorectal/GI cancers 74/147 (50.3%) as the most common indications. Maximum referrals were direct from Oncologist 84/147 (57.1%). Tumor board access was reported by 75/147 (50.3%), yet only 40/147 (27.2%) participated regularly. Key barriers included low awareness 117/147 (79.6%), cost constraints 108/147 (73.5%), limited access to oncology GC training 78/147 (53.1%) and lack of recognition 37/147 (25.2%). 92/147 (62.6%) expressed willingness to adopt tele-genetics and AI-based tools. Priority needs identified as oncology-focused GC training 49/147 (33.3%), recruitment of additional counsellors in oncology centres 41/147 (27.9%) and government recognition 39/147 (26.5%). Conclusions: India’s first nationwide assessment of genetic counsellors identifies a major mismatch between cancer burden and GC capacity, germline-centric practice and limited oncology integration. Readiness to adopt digital and hybrid models supports a scalable framework using digital pre-test education, tele-genetics, AI-assisted risk assessment tools for Indian population and tiered clinician training to optimize workforce, integrate genomics into routine care and expand equitable access to precision oncology. The findings inform workforce planning, implementation science and policy action in India and further other low- and middle-income countries.