All Family History Forms that meet the minimum referral criteria are sent to the central WMFACS team in Birmingham for assessment. Each form is processed as follows:

Step 1: The form is allocated to a named Family History Co-ordinator in the WMFACS team who will be responsible for it throughout the assessment process.

• The Family History Co-ordinator will deal with, or oversee all aspects of the Family History Form assess process, send consent forms (see step 3) to the patient, and deal with any enquiries that arise throughout the process.  

Step 2: The WMFACS database is checked to see whether the patient is already known to WMFACS, and the patient is registered on the database.

• Sometimes a patient can be referred more than once via different services, or the patient may be registered as a relative of another WMFACS patient. If the patient or family is already known, this usually means that steps 3 and 4 can be skipped.

Step 3: Consent forms to view cancer registry/medical records are sent to living relatives who have had cancer.

• These forms are ALWAYS sent to the patient with a covering letter asking them to forward the consent forms to their relatives. This is so that the patient can determine whether it is appropriate to forward the forms, and to allow the patient the opportunity to explain the referral to their relatives. Also, it may cause the relatives anxiety if they were to unexpectedly receive consent forms in the post directly from WMFACS  

Step 4: Cancer registry records, and occasionally medical records, are requested on all affected relatives where sufficient information is supplied.

• Cancer registry records are requested in order to confirm the site(s) of cancer and date/age of diagnosis, so that the risk assessment is as accurate as possible. Cancer registries supply a minimum dataset of information, usually confirming demographic details plus details of the site, (occasionally morphology), laterality and date of cancer diagnosis.
• Medical records are usually only requested where confirmation of bowel polyps is required, as this information is not usually held in cancer registry records. Photocopies of relevant records are requested rather than the entire set of notes for a patient/relatives. Alternatively, histological reports may be requested instead of notes.
• Consent is not required for relatives who are no longer alive. Records are not requested on relatives who are alive unless they have completed, signed and returned a consent form to WMFACS.

Step 5: The pedigree is constructed and the history is assessed by a Consultant Clinical Geneticist.

• The Family History Form, pedigree and medical history form are reviewed by the Consultant in order to determine if the patient is at increased (moderate or high) risk, or at near-population risk. The individual management strategy will be determined for the patient, based on the level of risk.

Step 6: A standard letter is sent back to the referring clinician and GP (if not the referring clinician), and other relevant services.

• The letter will describe the outcome of the Family History Form assessment, and outline the management strategy for the patient, if appropriate. A letter may also be sent to the local surveillance service if the patient will require surveillance.
• Depending upon the outcome, the patient will also receive a standard letter and information sheet explaining the outcome.

The whole assessment process usually takes about three months to complete from receipt of the Family History Form to sending an outcome letter. The process is most commonly delayed if consent forms are not returned to the WMFACS team.