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Tuesday, 25 August, 1998, 23:17 GMT 00:17 UK
GPs to get help to assess cancer risk
GP
GPs need help in assessing the risk of inherited cancer
GPs are to have special training to help them assess the risk of inherited cancers in their patients.

The Cancer Research Campaign is developing education packs to assist GPs, most of whom have little knowledge about inherited cancer.

It is hoped to include the information in a computer package also being developed by the CRC in parallel. The software should aid diagnosis by providing GPs with a statistical assessment of risk.

Breast cancer will be the first disease targetted, but it is hoped to extend the packs to cover other cancers.

The move is intended to help GPs cope with growing demand for information about these diseases.

Women in particular are seeing their doctors for advice because they have a relative with breast cancer.

Referral decisions

The new advice is aimed to help GPs:

  • Make the right referral decisions.

  • Explain the options open to women at high risk.

  • Reassure the majority of patients who have little chance of developing an inherited cancer.

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Dr Joan Austoker, who leads the CRC Primary Care Education Research Group, said: "People turn to their GP when they have a health related problem, but family doctors don't yet have the expertise to talk about this very complex and sensitive subject.

"This is not the fault of GPs or of medical schools. Our knowledge of cancer genetics has expanded very rapidly in recent years and is still expanding.

"Family doctors should be properly equipped to deal with patient concerns, for the sake of the women involved and to prevent inappropriate referrals to busy genetics clinics."

Colleague Dr Eila Watson said breast cancer had been targetted first because it was a relatively common form of the disease.

"It is present in the minds of a lot of women," she said.

GPs need help

Dr Gabriella Tobias, a GP in Hackney, East London, who has written guidelines on the management of breast disease, including cancer, welcomed the new packs.

She said: "GPs have a good idea about which cancers run in families, but they may not have an accurate idea of the risk."

Dr Tobias said the problem was compounded by a lack of available specialist resources, which sometimes made GPs reluctant to address the issue.

Expert consultation

The CRC team has already started work with GPs in Oxfordshire and colleagues in Sheffield and Nottingham to assess how family doctors currently deal with cancer.

They will also be talking to women who have been referred to genetics clinics.

About 5% of breast, bowel and ovarian cancers are influenced by genes which greatly increase the risk of getting the diseases and acquiring them at a young age.

Scientists have speculated that there may also be "medium risk" genes linked to a further 10 to 20% of these cancers.

Clear expectations

The CRC's director of clinical programmes, Dr John Toy, said: "Most doctors will have a number of patients who have a close relative, a parent or sibling, who has had breast or ovarian cancer.

"These women may well be worried about cancer but don't necessarily have an increased chance of inheriting a risk-giving gene. This work will help family doctors deal with patients' concerns and to give them clear expectations."

In recent years two breast cancer genes have been identified, known as BRCA1 and BRCA2. Between them they are thought to be responsible for breast cancers in about 80% of families with four or more cases of the disease diagnosed at under 60 years of age.

BRCA1 is also believed to be behind about 3% of cases of ovarian cancer.

See also:

24 Aug 98 | Health
Cancer alert for babies
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