Family history of cancer

Most GPs will receive many queries from patients concerned about whether cancer runs in their family. 

Because cancer is common, with a 1 in 3 lifetime risk, many of us will have a history of cancer within the family, but familial cancers only account for approximately 5%-10% of all cancers. 

A GP needs to feel confident in reassuring the vast majority of patients that they are at general population risk (low risk) whilst being able to identify those who are at possible increased risk who would benefit from a referral to Genetics.

Referral Guidelines for use in Primary Care have been developed in association with the Northern Genetics Service (2008).  These cover the three main familial cancers which are breast, bowel and ovarian, and are based on current national guidelines. 

All referrals to the Genetics Department must include a completed Family History Questionnaire. This allows the Genetics Department to verify all cancer diagnoses with the Cancer Registry and allows an accurate assessment of a patient’s risk.

When to suspect familial cancer

There are some clues in a patient’s history which may suggest the possibility of a familial cancer.

• The same cancer or related cancers in two or more close relatives (on the same side of the family).
• Cancer diagnosed in relatives at a young age.
• Multiple primary cancers occurring in the same person.
• Bilateral or multiple rare cancers.
• Known associated groupings of cancers e.g. breast & ovarian, bowel & endometrium, breast & sarcoma.
• An autosomal dominant pattern of inheritance.

How to use the guidelines

Take a three generational family history of both sides of the family (i.e. the patient, the parents and the grandparents.)

Use the guidelines (on one of the following pages) to categorise your patient as either ‘green’ or ‘amber’.

If a patient falls into the ‘green’ category discuss with them that they are not at any significantly increase risk of developing cancer, above that of the average member of the population, and therefore are unlikely to benefit from a referral to Genetics.

Patients may find helpful the general advice on Reducing Your Cancer Risk given on the NHS website.

If a patient falls into the ‘amber’ category, discuss with them that a referral to Genetics is advisable. Send referral with the patient’s completed Family History Questionnaire (see above).

Inform your patient that following receipt of the referral there could be a number of outcomes:

Taking into account the information in the referral and Family History Questionnaire the Genetics Department may decide that the patient remains in the ‘population risk’ or ‘green category’ and does not need further assessment.  This situation can occur because the guidelines are over inclusive.

The patient may be referred directly for increased surveillance e.g. mammography or colonoscopy.  They will receive detailed information about their genetic risk but will not actually be seen in the Genetic Department.  This tends to apply to those patients at ‘moderate risk’ of cancer.

The patient may receive an appointment to be seen in the Genetics Department by a Geneticist or Genetic Counsellor.

Points to be aware of

It is important to make patients aware that their risk could be affected if there is a new diagnosis of cancer within the family. In this case they should be advised to return for a further assessment.

A family member with bilateral primary cancers counts as two separate relatives for the purpose of the guidelines.

Some patients may have a family history of unusual cancers or a family history which appears suspicious but doesn’t fit within the guidelines.  If this is the case please seek further advice from the Genetics Department.

Telephone: 0191 241 8721