Familial Cancer Service, Westmead Hospital, NSW.
Familial Cancer Unit, Womens and Childrens Hospital, North Adelaide, South Australia.
A new diagnosis of cancer has been made and – after the initial questions about staging and treatment have been tackled – the patient often asks “Does this mean my relatives are at increased risk of cancer?” The answer depends on a number of features: the specific type of cancer, the age at cancer diagnosis and the presence or absence of the same (or associated) cancers in other family members. This assessment can usually be left until treatment is well underway, but sometimes the diagnosis of a genetic susceptibility to cancer can have an immediate impact on the treatment options that can be offered.
The family history can be important for the care of both the patient and family at large and so the taking of a clear family history is not an option – it is an essential part of the care provided by every healthcare professional. When there is uncertainty about the significance of a family history of cancer, this is best addressed by referral to a familial cancer service. Familial cancer clinics are now an important component of contemporary multidisciplinary cancer care.
This issue of Cancer Forum provides an overview of the way in which familial cancer services operate. A general introduction to cancer susceptibility and genetic testing is provided by Judy Kirk, while Graeme Suthers tackles some of the complex issues around genetic testing and information management. The most commonly referred histories are those involving breast/ovarian cancer and bowel cancer, highlighted in articles written by Kathryn Field with Kelly-Anne Phillips and Barbara Leggett (respectively); management of the high-risk individual is addressed in detail. Paediatric malignancies may be involved in a variety of cancer predisposition syndromes, reviewed by Michael Field. Finally, advances in two relatively new areas (hereditary diffuse gastric cancer, discussed by Georgina Fenton) and familial haematological malignancy (discussed by Catherine Carmichael and Hamish Scott) highlight that the field of clinical cancer genetics is expanding.