There has been a rapid expansion of genetic testing for hereditary cancer syndromes in oncology.  In Ontario’s publicly funded health care system, a standardized approach to testing across the province supports equitable access.  This study describes an method for establishing consensus on hereditary cancer testing across a broad spectrum of tumour types.  This framework can be used by other health systems faced with similar pressures to ensure updated and current hereditary cancer testing for their citizens.  The data presented may be useful in genetic counselling for individuals and families at risk for hereditary cancer syndromes. (By Kathleen Bell, https://jmg.bmj.com/content/early/2022/12/23/jmg-2022-108945 )