We have a unique “cross-border” conversation with two experienced genetic counselors from the U.S. and Canada, as they review healthcare delivery in their countries, as well as hereditary cancer panel use in their specific regions. We review practical solutions to U.S. and Canadian clinicians facing dilemmas to help us learn from each other, and navigate any pitfalls in the process. Content has been reviewed by the Canadian Association of Genetic Counsellors' (CAGC) Board of Directors, and the CAGC has professionally endorsed it.