Abstract
The objective was to describe NHS cancer genetic counselling services and compare UK regions. The study design was a cross-sectional study over 4 weeks and attendee survey. The setting was 22 of the 24 regional cancer genetics services in the UK NHS. Participants were individuals aged over 18 attending clinics at these services. Outcome measures were staff levels, referral rates, consultation rates, follow-up plans, waiting time. There were only 11 dedicated cancer geneticists across the 22 centres. Referrals were mainly concerned with breast (63%), bowel (18%) and ovarian (12%) cancers. Only 7% of referrals were for men and 3% were for individuals from ethnic minorities. Referral rates varied from 76 to 410 per million per annum across the regions. Median waiting time for an initial appointment was 19 weeks, ranging across regions from 4 to 53 weeks. Individuals at population-level genetic risk accounted for 27% of consultations (range 0%, 58%). Shortfalls in cancer genetics staff and in the provision of genetic testing and cancer surveillance have resulted in large regional variations in access to care. Initiatives to disseminate referral and management guidelines to cancer units and primary care should be adequately resourced so that clinical genetics teams can focus on the genetic testing and management of high-risk families. © 2001 Cancer Research Campaign http://www.bjcancer.com
Keywords: genetic counselling, cancer genetics services, health service organization, Calman-Hine
Full Text
The Full Text of this article is available as a PDF (53.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brain K., Gray J., Norman P., France E., Anglim C., Barton G., Parsons E., Clarke A., Sweetland H., Tischkowitz M. Randomized trial of a specialist genetic assessment service for familial breast cancer. J Natl Cancer Inst. 2000 Aug 16;92(16):1345–1351. doi: 10.1093/jnci/92.16.1345. [DOI] [PubMed] [Google Scholar]
- Emery J., Walton R., Coulson A., Glasspool D., Ziebland S., Fox J. Computer support for recording and interpreting family histories of breast and ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients. BMJ. 1999 Jul 3;319(7201):32–36. doi: 10.1136/bmj.319.7201.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Emery J., Walton R., Murphy M., Austoker J., Yudkin P., Chapman C., Coulson A., Glasspool D., Fox J. Computer support for interpreting family histories of breast and ovarian cancer in primary care: comparative study with simulated cases. BMJ. 2000 Jul 1;321(7252):28–32. doi: 10.1136/bmj.321.7252.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hodgson S., Milner B., Brown I., Bevilacqua G., Chang-Claude J., Eccles D., Evans G., Gregory H., Møller P., Morrison P. Cancer genetics services in Europe. Dis Markers. 1999 Oct;15(1-3):3–13. doi: 10.1155/1999/134945. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leggatt V., Mackay J., Yates J. R. Evaluation of questionnaire on cancer family history in identifying patients at increased genetic risk in general practice. BMJ. 1999 Sep 18;319(7212):757–758. doi: 10.1136/bmj.319.7212.757. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morrison P. J., Nevin N. C. Cancer genetics services in Northern Ireland. Dis Markers. 1999 Oct;15(1-3):37–40. doi: 10.1155/1999/161754. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moynihan C. Theories in health care and research: theories of masculinity. BMJ. 1998 Oct 17;317(7165):1072–1075. doi: 10.1136/bmj.317.7165.1072. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murday V. Genetic counselling in the cancer family clinic. Eur J Cancer. 1994;30A(13):2012–2015. doi: 10.1016/0959-8049(94)00395-l. [DOI] [PubMed] [Google Scholar]
- Peshkin B. N., Lerman C. Genetic counselling for hereditary breast cancer. Lancet. 1999 Jun 26;353(9171):2176–2177. doi: 10.1016/S0140-6736(99)90078-8. [DOI] [PubMed] [Google Scholar]
- Ponder B. A. Setting up and running a familial cancer clinic. Br Med Bull. 1994 Jul;50(3):732–745. doi: 10.1093/oxfordjournals.bmb.a072921. [DOI] [PubMed] [Google Scholar]
- Sobol H., Bignon Y. J., Bonaiti C., Cuisenier J., Lasset C., Lortholary A., Noguès C., Stoppa-Lyonnet D., Eisinger F. Four years analysis of cancer genetic clinics activity in France from 1994 to 1997: a survey on 801 patients. French Cooperative Network/Groupe Génétique et Cancer de la Fédération Nationale des Centres de Lutte Contre le Cancer. Dis Markers. 1999 Oct;15(1-3):15–29. doi: 10.1155/1999/140498. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thompson J. A., Wiesner G. L., Sellers T. A., Vachon C., Ahrens M., Potter J. D., Sumpmann M., Kersey J. Genetic services for familial cancer patients: a survey of National Cancer Institute cancer centers. J Natl Cancer Inst. 1995 Oct 4;87(19):1446–1455. doi: 10.1093/jnci/87.19.1446. [DOI] [PubMed] [Google Scholar]
- Warner E., Foulkes W., Goodwin P., Meschino W., Blondal J., Paterson C., Ozcelik H., Goss P., Allingham-Hawkins D., Hamel N. Prevalence and penetrance of BRCA1 and BRCA2 gene mutations in unselected Ashkenazi Jewish women with breast cancer. J Natl Cancer Inst. 1999 Jul 21;91(14):1241–1247. doi: 10.1093/jnci/91.14.1241. [DOI] [PubMed] [Google Scholar]
- de Bock G. H., van Asperen C. J., de Vries J. M., Hageman G. C., Springer M. P., Kievit J. How women with a family history of breast cancer and their general practitioners act on genetic advice in general practice: prospective longitudinal study. BMJ. 2001 Jan 6;322(7277):26–27. doi: 10.1136/bmj.322.7277.26. [DOI] [PMC free article] [PubMed] [Google Scholar]