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Cancer Genetics Service for Wales (CGSW)

The Cancer Genetics service for Wales (CGSW) is part of the All Wales Medical Genetics Service (AWMGS). It was established with funding from the National Assembly for Wales and Macmillan Cancer Relief in early 1999 to respond to the increasing demand for information and clinical care for women and men at risk of cancer because of a family history. Its remit is to assess the risk of cancer based on a patient's reported family history and work with the relevant specialists to recommend further screening strategies where appropriate.

5 - 10% of cancers of the breast, ovary and colon are due to an inherited predisposition. Individuals who meet the referral criteria and who may therefore be at a significantly increased risk of developing cancer can also be referred to the CGSW. Our remit is to assess the risk of cancer based on the reported family history, to work with the relevant specialist clinicians and recommend screening strategies where appropriate. The referral criteria suggest who may be at a significantly increased risk of an inherited form of cancer.

Process: On receipt of a referral

• A family history questionnaire is sent to the patient, to identify family history and baseline information.
  (We only take the referral further if the questionaire is returned)
• Where necessary, the family history is clarified and confirmed.
• A risk assessment is indertaken to categorise the patient as 'High','Moderate' or 'Average' risk.
• The patient, referring doctor and GP are informed of the risk category.
• All high-risk and some moderate-risk patients are offered an appointment in  the Cancer Genetics clinic.
• All patients are given contact details for the Cancer Genetics Service and invited to recontact us in the event of a change in family history.

Average Risk

We aim to reassure this group that, on the information given, their risk is not significantly raised above that of the general population, so extra surveillance is not recommended. They should continue standard health awareness and screening as for the general population.

Moderate Risk

We aim to facilitate or coordinate ongoing management between primary care and appropriate specialist clinicians(e.g. local breast or colorectal surgeons) or screening organisations (e.g Breast Test Wales). Patients maybe referred directly by the Cancer Genetics Service or we will suggest an appropriate referral route for the GP. In some cases laboratory investigations may be recommended to help clarify a patient's risk status.

High Risk

In addition to suggesting the involvement of other specialist clinicians and recommending appropriate surveillance,this group will be seen in the Cancer Genetics clinic and genetic testing may be offered in some families.

An appointment in the Cancer Genetics clinic offers

• Time to discuss concerns about a family history of cancer and implications for both the patient and other family members.
• Referral or recommendation for appropriate screening/surveillance.
• Storage of DNA and organisation of genetic testing, where appropriate.
• Opportunity to participate in research studies.