Proactive familial cancer risk assessment: a service development study in UK primary care

Abdul Rahman Badran; Alice Youngs; Andrea Forman; Marisa Elms; Lai-Lai Chang; Fiyaz Lebbe; Adam Reekie; John Short; Min Theik Hlaing; Emma Watts; Deborah Hipps; Katie Snape

doi:10.3399/BJGPO.2023.0076

Proactive familial cancer risk assessment: a service development study in UK primary care

BJGP Open. 2023 Dec 19;7(4):BJGPO.2023.0076. doi: 10.3399/BJGPO.2023.0076. Print 2023 Dec.

Authors

Abdul Rahman Badran^{1

2}, Alice Youngs³, Andrea Forman³, Marisa Elms³, Lai-Lai Chang⁴, Fiyaz Lebbe², Adam Reekie³, John Short³, Min Theik Hlaing³, Emma Watts⁵, Deborah Hipps⁶, Katie Snape³

Affiliations

¹ South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK abdul.badran@nhs.net.
² Fieldway Medical Centre, Danebury, New Addington, Croydon, UK.
³ South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK.
⁴ West Barnes Surgery, West Barnes Lane, London, UK.
⁵ Shere Surgery, Gomshall Lane, Guildford, UK.
⁶ The Exchange Surgery, Gracefield Gardens, London, UK.

PMID: 37591554
DOI: 10.3399/BJGPO.2023.0076

Abstract

Background: Family history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention, and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer risk assessment is usually only offered to concerned individuals proactively self-presenting to their GP, leading to inequity in accessing SPED in the community.

Aim: To improve access to community cancer genetic risk assessment and explore barriers to uptake.

Design & setting: Service development project of a digital pathway using the FHQS for cancer risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG).

Method: 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake.

Results: In total, n = 304/3100 (10%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, P<0.001), speak English as their main language (92% vs 76%, P<0.001), and not require an interpreter (99.6% vs 94.9%, P = 0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral (n = 23), genetics referral (n = 15), and/or advice to relatives (n = 18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details (n = 26), losing the invitation (n = 5), or forgetting (n = 4).

Conclusion: The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlighted barriers to uptake requiring consideration to maximise impact and minimise inequity.

Keywords: early detection of cancer; general practitioners; medical history taking; primary health care.