CANCER FAMILIES - WHAT RISKS ARE THEY GIVEN AND DO THE RISKS AFFECT MANAGEMENT

The numbers of referrals to genetics clinics for people with a family history of cancer is increasing rapidly. Although it is likely that pr esymptomatic testing will soon be available for some families, for the majority of people with a family history of malignancy, risk can only be assessed by examining their pedigrees and referring to standard te xts. In order to find out if clinical geneticists are providing consis tent risks and suggestions for management we surveyed consultant clini cal geneticists with a questionnaire about four people with a family h istory of malignancy. The clinical geneticists replying to our questio nnaire gave consistent advice for the person with a family history of colon cancer, but there was wide variation in suggested risks and mana gement for those with family histories of breast and multisite cancers . This survey shows that deciding on appropriate management for cancer families can be difficult and that there is uncertainty about the mos t effective methods of screening young people at high risk of developi ng cancers. However, it is important to provide consistent advice in o rder to evaluate screening protocols and lack of consistency in advice given to different family members can cause anxiety and distress. Con sistency may be achieved by the use of one model for risk calculation, and by representatives from several specialities, such as surgery, ra diology, genetics, and public health working together in order to coor dinate local and national screening policies.