The Cancer Genetics Service aims to:

• Provide an accessible service, which includes: risk assessment, information, psychological, emotional and physical support of individuals who are at increased risk of developing cancer due to their family history.
  
  
• Use a multidisciplinary team approach to assess the needs of individual patients, the appropriate level of intervention and care can be suggested.
  
  
• Provide direct support and counselling to the 500 high risk families already referred and for future referrals.
  
  
• Provide information, training, and support for healthcare professionals who are involved in providing genetic information to families through primary care or cancer clinics.

There has been a huge growth in referrals of families concerned about the inherited basis of cancers over the last five years. They now constitute over 30% of the departmental workload. In the main this is centred on the common cancers of:

• familial breast cancer
  
  
• familial ovarian cancer
  
  
• familial bowel cancer
  
  
• hereditary non-polyposis colon cancer (HNPCC)
  
  
• familial adenomatous polyposis (FAP)

and the rarer, but more specific cancer predisposition syndromes:

• Von Hippel Lindau disease
  
  
• Gorlin's syndrome
  
  
• Neurofibromatosis type I and type II
  
  
• Li Fraumeni syndrome
  
  
• Ataxia Telangiectasia and chromosome breakage disorders
  

Mersey & Cheshire Clinical Genetics Service - Cancer Genetics

Referral Guidelines for Patients Concerned due to Family History Breast/Ovarian Cancer
The following criteria should be used to assess if your patient is at increased risk of ovarian cancer and if she is likely to benefit from referral to the Genetic Counselling Service at the Countess of Chester Hospital. This clinic offers genetic risk assessment and recommendations for clinical surveillance if appropriate. If you feel that your patient would benefit from a genetic counselling referral please discuss referral with a member of the genetics team.

Ovarian Cancer Referral Guidelines

(all associated with at least 10% ovarian cancer risk) The family must be at increased risk (as defined below). The patient must be a first degree relative of an affected family member. The family contains 2 or more individuals on the same side of the family with ovarian cancer who are first degree relatives of each other. (or 2 close relatives on the same side of the family - please discuss with a member of the genetics team). or The family contains one individual with ovarian cancer at any age and one individual with breast cancer diagnosed under the age of 50 years, who are first degree relatives of each other. or The family contains one individual with ovarian cancer at any age and two individuals with breast cancer diagnosed under the age of 60 years who are connected by first degree relationships. or The family contains one individual with one of the known cancer predisposing genes. or The family contains three individuals with colorectal cancer with at least one case diagnosed before 50 years and one case of ovarian cancer connected by first degree relationships.

Breast Cancer Referral Guidelines
Possible Moderate Risk Group (Lifetime risk approximately 16 - 25%) Breast cancer in: 1 first degree relative <40 or 1 first degree relative with bilateral disease (first tumour <60) or 1 male first degree relative or 2 first degree relatives average age <60 (e.g. mother-sister; two sisters)		Refer to local family history breast surveillance clinic. Advise monthly breast self examination Annual breast clinical examination Baseline mammography at 35 years Mammography every 12 months 40-50 years Discharge to National Breast Screening Program at 50 years. If below 35 re-refer at 35 or 5 years before youngest cancer in the family.
Possible High Risk Group (Lifetime risk approximately above 25%) 3 close relatives on the same side of the family average age <60 or 2 close relatives average age <40		Refer to local family history breast surveillance clinic and to clinical genetics service (genetic counselling) Advise monthly breast self examination Annual breast clinical examination to 60 years Baseline mammography 35 years Mammography every 12 months 40-50 Mammography every 18 months 50-60 to alternate with National Breast Screening Program Discharge at 60 years. If below 35 re-refer at 35 or 5 years before youngest cancer in the family.

Referrals for high risk families should be made to:
Dr Ian Ellis or Dr Alan Fryer or Dr Anthony Ellis (Gastroenterology Genetics)
Clinical Genetics - Referrals
Alder Hey Hospital
Eaton Road
Liverpool
L12 2AP

Partnership Clinics

This logo is used to identify services supported by the cancer genetics service of the Merseyside and Cheshire Clinical genetics Services. It is hoped to continue to support and develop a number of breast cancer family history screening clinics across the zone which will act as the first line contact for GP's wishing to refer women.

The current partner Family History Breast Screening Clinics are:

Sue Holcolme
Family History Breast Screening Clinic (Prof Leinster)
Royal Liverpool University Hospital
Prescot Road
Liverpool
L7 8XP

Family History Breast Screening Clinic
Southport and Formby District General Hospital
Town Lane
Southport
PR8 6PN

Ann Monahan
Breast Nurse
Family History Breast Screening Clinic
University Hospitals Aintree NHS Trust
WALTON
Rice Lane
Liverpool
L9

Miss Leena Chagla
Consultant Breast Surgeon in Whiston
Whiston Breast Services
Whiston Hospital
St Helen's and Knowsley Hospitals
Whiston Hospital
Prescot
Merseyside
L35 5DR

Miss Liz Redmond
Breast Screening Family History Clinic
Countess of Chester hospital
Liverpool Road Chester
CH2 1UL