If a patient does not meet the referral criteria for breast, ovarian or colorectal family histories of cancer, the patient can be reassured that a referral is not necessary. The following may a useful guide in reassuring such patients:

These patients are at low genetic risk (near-population cancer risk) and do not need extra surveillance. They can be reassured that they have nearly the same level of risk as the near-population for developing cancer.

However, these patients have been sufficiently concerned about their family history to seek advice and therefore need an explanation of their risk in verbal or written format:

If the patient is inquiring about a family history of breast cancer and does not meet the referral criteria, they can be reassured, given a near-population risk breast information sheet and general health advice. The possible signs and symptoms of breast cancer and issues such as breast awareness can be discussed. If they are symptomatic they should be referred to their local service.

If the patient is inquiring about a family history of colorectal cancer and does not meet the referral criteria, they can be reassured, given a near-population risk colorectal information sheet, general health advice and the possible signs and symptoms of colorectal cancer can be discussed.

If the patient is inquiring about a family history of ovarian cancer and does not meet the referral criteria, they can be reassured, given a near-population risk ovary information sheet, general health advice and the possible signs and symptoms of ovarian cancer can be discussed. If they are symptomatic they should be referred to their local service.

Whilst reassuring the patient that they are at no increased risk of developing cancer, this may also be an opportunity to discuss lifestyle issues and the signs and symptoms of some cancers.

If you are concerned regarding a patient who falls outside the referral guidelines, for example patients with family histories of other cancer, or if there is a history of one or more of the features of a possible inherited predisposition (see the Quick guide to inherited cancers), please contact WMFACS for advice, or refer using the normal route for your area.