Principal role of primary care is not to seek out those at increased genetic risk

EDITOR—I am concerned about the implicit message underlying the study by Leggatt et al evaluating a questionnaire on cancer family history to identify patients at increased genetic risk—namely, the promotion of family history screening in primary care.1 The authors seem to assume that evidence is sufficient to justify proactively identifying people at increased genetic risk of cancer. However, assessment of family history falls far short of the Wilson and Junger criteria for a screening test.

The study of colonoscopy in patients with hereditary non-polyposis coli was a non-randomised controlled trial that did not find a significant effect on mortality at 10 years.2 The study of mammography was an observational study from a single cancer family clinic.3 Unfortunately, this is the best available evidence to support these surveillance methods in people at increased genetic risk of colorectal or breast cancer.

The authors acknowledge that a postal questionnaire is a poor screening tool because of the low response rate achieved with this method, but they suggest its …