Because cancer is common, with a one in three lifetime risk, many of us will have a history of cancer within the family, but familial cancers only account for approximately five to ten percent of all cancers.
A GP needs to feel confident in reassuring the majority of patients that they are at general population risk (low risk) whilst being able to identify those who are at possible increased risk who would benefit from a referral to genetics.
Referral guidelines for use in primary care have been developed in association with the Northern Genetics Service (2008). These cover the three main familial cancers which are breast, bowel and ovarian, and are based on current national guidelines.
When to suspect familial cancer
There are some clues in a patient’s history which may suggest the possibility of a familial cancer.
- The same cancer or related cancers in two or more close relatives (on the same side of the family)
- Cancer diagnosed in relatives at a young age
- Multiple primary cancers occurring in the same person
- Bilateral or multiple rare cancers
- Known associated groupings of cancers. For example, breast and ovarian, bowel and endometrium, breast and sarcoma
- An autosomal dominant pattern of inheritance
Complete an online referral form
Visit the online referral form webpage to complete a referral.
Informing your patient
Inform your patients that following receipt of the referral there could be a number of outcomes
A family history questionnaire is sent to collect as much information as possible about the cancers in the individual and/or their family.
The team gathers information from various sources to confirm the reported diagnoses.
Individuals are then assigned a level of risk
- Patients at low risk can be reassured they require no surveillance and no genetic counselling
- Patients at moderately increased risk will be given an appointment with the genetic risk assessment practitioners to discuss the risk assessment and entered into an appropriate disease surveillance programme
- Patients at high risk of cancer will be offered an appointment with a genetic counsellor or consultant clinical geneticist. They will be given information about their risk, surveillance, genetic testing and risk reducing surgery if necessary
There are some individuals from whom no accurate risk assessment can be made, or who have extremely rare cancer predisposition syndromes.
Their management will be tailored to their need. These individuals will be seen by the consultant clinical geneticist.