Ancestry and Health: Dr. Altovise T. Ewing ’05 Makes Impact With Genetic Counseling

Dr. Altovise Ewing graduated from Rhodes College in 2005 with a bachelor’s degree in biology and went on to receive a doctorate in genetics from Howard University. She now is one of the few Black Ph.D.-trained and board-certified genetic counselors in the United States.

Genetic counselors interpret genetic testing results, piece together family health history details to determine patterns of inherited diseases and conditions, and provide risk estimates to patients and other family members, including the unborn. They also counsel patients on what next steps to consider after testing.

Ewing has trained and worked in various settings such as the Walter Reed National Military Medical Center, the Bloomberg School of Public Health at Johns Hopkins, Cancer Treatment Centers of America and 23andMe, which is one of the largest direct-to-consumer genetic testing companies. Currently, she is a senior science leader for global health equity strategy at the biotechnology company Genentech. Her work has been published in medical journals and her expertise has been featured in popular media such as NPR and O, The Oprah Magazine.

Ewing was fascinated with her family history while growing up in Pulaski, TN, and with DNA testing traced her Nigerian, Ghanaian, Liberian, Sierra Leonean, Senegambian, and Congolese heritage. As more people have become interested in tracing their ancestry and identifying inherited diseases and health conditions, the demand for genetic expertise has increased. However, when the National Society of Genetic Counselors administered its annual survey in 2020 on the demographics of its members, only two percent of respondents identified as Black or African American.

Ewing says she is committed to creating a future that fosters equity, diversity, and inclusion, both for those working in the field of genetic counseling and for those whom genetic counselors assist. She recently took time out of her busy schedule to answer questions from Rhodes regarding her work.

Why is eliminating disparities in genetic counseling and testing a critical issue?

Answer: In order to successfully and equitably deliver on the promise of precision medicine, it is essential that we eliminate disparities in genetic counseling and testing. Genetic counseling is a resource that will help us unlock and maximize the potential within the Human Genome. But in order to do so in a way that all of society will benefit from the advancements that ensue in genetics and genomics, we need more genetic counselors from underrepresented groups and diverse walks of life at the table. Ensuring that the diversity within the genetic counseling profession mirrors that of the society we serve and the populations most in medical need is an ethical imperative. Solving for this critical issue could lead to more just and equitable outcomes in genetic testing uptake and utility, beneficial research advancements, and healthcare quality.

What are some reasons that racial and ethnic/minority groups are less likely to see a genetic counselor?

Answer: Inequities in access to genetic counseling persist at various levels. In some cases, racial and ethnic/minority groups are less likely to be offered genetic counseling as an option. Some studies have revealed that even when patients from racial/ethnic minority groups meet criteria for genetic counseling and testing, they are still less likely to be referred for counseling. There are also other instances when an individual may decide not to pursue genetic counseling, because it may not be a resource of interest, may not be covered by their insurance, may conflict with one’s cultural beliefs or it may be offered at an inopportune time during a patient’s journey when it’s difficult to prioritize the service.

What are ways for individuals to find out what conditions/diseases run in their families?

Answer: Commencing and continuing a conversation with family members about family health history is the best way to learn if there are conditions/diseases that run in your family. However, in some cases, it may not be an option for some individuals to obtain family health history information. This is when it could be helpful for you to talk to your healthcare provider about your personal history combined with the consideration of undergoing clinical genetic testing or a direct-to-consumer (DTC) or consumer initiated genetic test.  It is definitely recommended to talk to a healthcare provider, such as a genetic counselor, about your results, so that they can help you understand results precisely within the context of your health and circumstances. Genetic counselors can also discuss options available to you to ensure that your medical management is timely and tailored to your specific needs.

How do genetic counselors equip people with the information needed to make informed decisions about undergoing genetic testing?

Answer: Genetic counselors work in a variety of settings. Typically, a genetic counselor will meet with a patient during a pre- and post consultation. During the first session, the genetic counselor will assess the patient’s motivation and understanding for the session as well as take a thorough family health history. The genetic counselor will also provide a risk assessment as well as an overview of appropriate genetic testing options for the patient to consider, if the patient meets criteria. The informed consent process is prioritized as the genetic counselor and patient discuss the patients’ concerns and questions and review the benefits and limitations of genetic testing as well as the type of test that is ordered, which can vary by race and ethnicity. Genetic counseling is a non- directive service, so the patient is empowered with information to make an autonomous decision to pursue, decline, or defer genetic testing until one is comfortable.

How did your time at Rhodes lead to your post-graduation choices?

Answer: Rhodes opened the door to a plethora of opportunities that I never knew existed. It was fall semester of my senior year of college that I was introduced to a profession that would not only change my life, but also afford a chance for me to have an impact on the world. I have had numerous opportunities to disrupt disparities along the genetics continuum. I credit Rhodes for helping me to realize my abilities were fit for devising health equity solutions at the intersection between genetics and disparities.

Any last comments?

Answer: My Rhodes experience may not have been everything I imagined, but it was everything that I needed at the time. Rhodes prepared me, advertently and inadvertently, to thrive in a world where I am, at times, the only person of color, the only impassioned voice and the only dissenting opinion in the room, but also an unapologetic and unwavering champion who stands for justice. My Medical Sociology and Genetics classes left indelible marks on my pursuit for purpose.  And my experiences as a Bonner Scholar and a Black Student Association (BSA) officer prepared me for this moment. I’d also be remiss not to share that Rhodes granted me the privilege of crossing paths with lifelong friends who I cherish as family.

Rhodes remains an unyielding source of support and foundational cornerstone in my life. And for that, I count it all joy!