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GPs refer too many women for genetic tests

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.67/b (Published 12 January 2002) Cite this as: BMJ 2002;324:67
  1. Lynn Eaton
  1. London

    Many GPs are unnecessarily referring women for genetic tests for breast and ovarian cancer, a report from the Cancer Research Campaign and Imperial Cancer Research Fund has said.

    The two charities—which will merge in February—have said that many GPs lack confidence in counselling patients about inherited cancer risks. As a result, they tend to refer women who have a family history of breast or ovarian cancer for testing when they do not really need to.

    In many cases the patient's family history suggests that they are not at high risk of the disease, the researchers said. The women can be cared for by their GP without needing to attend a genetics clinic and without having to go through the additional worry that such tests bring.

    “Doctors currently lack the appropriate information and err on the side of caution when assessing their patients' likely risk of cancer,” said Dr Joan Austoker, of the Cancer Research Campaign's Primary Care Education Group in Oxford University.

    But the report has raised the hackles of the Royal College of General Practitioners. “GPs are as ever in a situation where they can't win,” said its chairman, Professor David Haslam. “If they don't refer they are criticised, but they are criticised if they do refer as well.”

    “A GP faced with a worried patient would be wrong not to refer,” he said.

    Dr Jonathon Gray, consultant in medical genetics at the University Hospital of Wales, said that the three clinics he runs, in Cardiff, Swansea, and Glan Clwyd, had seen a huge demand from women who were worried they might be at risk.

    In the past two years his clinics have introduced guidelines to help GPs to assess relative risk and avoid unnecessary referral.

    The charities' guidelines are available from the Cancer Research Council's Primary Care Education Research Group, University of Oxford Institute of Health Sciences, Headington, Oxford OX3 7LF.

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