“Below threshold” familial breast cancer risk information can be conveyed by letter, but attention should be given to further support for these women

Clinical services for familial breast cancer require a “threshold” to be set so that only women with a family history placing them at substantially increased risk are eligible, for example, for enrolment in special surveillance programmes. That threshold is generally set at around 1.7 times the general population risk. Despite widely-publicised guidelines, most clinics find that around 30% of women referred fall below the “threshold” risk level. This study set out to evaluate two methods of conveying to these women the information that they would not receive special screening, a personal letter or a face-to-face interview with a genetic counsellor. Eighty-seven women were randomised to one or other of these approaches and their experiences were evaluated later by means of a detailed questionnaire. Their family doctors (who had initiated referral to the cancer family clinic) were also surveyed.

Letter and interview were equally acceptable to the women though there was a slight preference for interview. The family doctors were generally satisfied with either procedure and only 4 women subsequently returned to their doctor with concerns about breast cancer risk. However understanding of information provided on absolute and relative risks of breast cancer was poor. Significant minorities of women from both the “letter” and the “interview” cohorts appeared to believe they were at very low risk – even lower than population level – while others did not accept reassurance and resented exclusion for special screening programme. We conclude that “below threshold” familial risk information can be conveyed by letter, thus reducing clinic costs , but attention should be given to further support for these women.

Bibliographic reference:

D Young, L McLeish, F Sullivan , M Pitkethly, M Reis, D Goudie, H Vysny, G Ozakinci and M Steel: "Familial breast cancer: management of “lower risk” referrals", Britich Journal of Cancer. 2006 Oct 23;95(8):974-8

Michael Steel

Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee, UK