There are several designated cancer family history clinics in centres across the region. Typically, these clinics are run by Specialist Nurses or Doctors, in collaboration with WMFACS.

Depending upon local arrangements, patients can be referred to a designated cancer family history clinic for family history assessment and advice, and to organise surveillance in moderate risk cases. Patients at high genetic risk should be referred to the clinical genetics service.

An important function of the cancer family history patient is to organise DNA banking with families.

Notes for Specialist Nurses in family history clinics.

Moderate risk patients

Patients who meet the referral criteria are referred on to the WMFACS team for Family History Form assessment according to the local strategy.

If assessed as meeting the moderate risk criteria, the patient may be offered an appointment to discuss risk and management issues at the local family history clinic, surveillance clinic or they may be seen by a genetic cousellor to discuss their risk, depending upon local arrangements. A clinical genetics appointment would not provide any additional management strategies at the current time.

The following is a guide to explaining the risk assessment outcome to patients. Directions on individual patients can be provided for Specialist Nurses.

Family history clinics - general notes

• Reassure the patient that based on current knowledge and the information available they are not at a high genetic risk, but may have an increased risk of developing cancer compared with the general near-population.
• Discuss the family history, check details, extend pedigree if necessary. Reassess the family history to ensure that patient management issues are not altered by any additional information that has been provided.
• Provide basic information on the mechanism of how sporadic cancers and cancers with a genetic influence may develop. Include information about their specific family history of cancer.
• Discuss patient management issues. Depending on family history, breast, ovarian or colorectal surveillance may be recommended. Health advice such as breast awareness and healthy lifestyles etc. may also be discussed.
• Explain the management of other family members if appropriate. For example, other members of the family may also need surveillance. An appointment can be offered to the relatives individually. Or a copy of the clinic summary letter can be given to the appropriate relatives by the patient, which they can then take to their own GP, who can arrange surveillance.
• The patient may have further questions which can be discussed.
• If applicable, DNA for storage ("banking") may needed. If the patient is agreeable, written consent must be obtained before the blood sample is taken (the blood sample can also be undertaken by phlebotomy services or at the GPs surgery). If blood for storage is required from a relative and they are willing, the mechanism for this will need to be arranged. Consent to access tumour tissue (if dealing with a colorectal cancer family) may be required.
• A summary letter and moderate risk information sheet can be sent to the patient following the appointment.
• Copies of surveillance results of patients known to the WMFACS team must be forwarded to WMFACS as soon as they are available.