Article

Familial Cancer

, Volume 5, Issue 4, pp 297-303

First online:

Analysis of referrals to a multi-disciplinary breast cancer genetics clinic: practical and economic considerations

  • Marta M. ReisAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School
  • , Dorothy YoungAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School
  • , Lorna McLeishAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School
  • , David GoudieAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School
  • , Alan CookAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School
  • , Frank SullivanAffiliated withCommunity Health Sciences Division, University of Dundee Medical School
  • , Helen VysnyAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical SchoolBute Medical School, University of St Andrews
  • , Alison FordyceAffiliated withInformation and Statistics Division (NHS Scotland)
  • , Roger BlackAffiliated withInformation and Statistics Division (NHS Scotland)
    • , Manouche TavakoliAffiliated withDepartment of Management, University of St Andrews
    • , Michael SteelAffiliated withTayside Breast Cancer Family Clinic, Ninewells Hospital and Medical SchoolBute Medical School, University of St Andrews Email author 

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Abstract

Analysis of activity was undertaken in an established regional clinic providing risk assessment, counselling, screening and management for women with a family history of breast or ovarian cancer. The objectives were to determine: (1) how closely the route and pattern of referrals matched official guidelines (2) whether the previously recorded socio-economic imbalance among clinic clientele persisted and (3) the economic and practical consequences of committing resources to verification and extension of reported family histories. The findings were: (1) after some years of operation, the proportion of referrals direct from primary care had increased from less than 50% to over 75%, with a concomitant slight decrease in overall referral rate; (2) the socio-economic distribution of patients referred had become less selective and (3) extension and verification of reported family histories led to a redistributuion of risk categories, increasing the proportion of referrals judged to be in the “low risk” category, from 25% (based on referral letter alone) to 41% (at the end of the process). The costs associated with this approach are offset by the savings generated and it allows specialised counselling and screening services to be targeted more efficiently.

Keywords

Breast cancer Familial Genetic Clinical services Risk Assessment Economics Primary care