Moderate risk patients

Patients at moderately increased risk of developing cancer may benefit from extra surveillance. Explanation of risk could be given to patients within the family history clinic/surveillance units. A clinical genetics appointment would not provide any additional management strategies at the current time. Patients assessed as meeting the moderate risk criteria may be offered an appointment to discuss risk and management issues at the local surveillance unit, or they may be seen by a Genetic Cousellor to discuss their risk, depending upon local arrangements. Directions on individual patients can be provided for clinicians.

At a surveillance unit appointment, surveillance and/or the results of any surveillance undertaken may be discussed as well as the information about the family history and genetic risk.

Surveillance clinics - general notes

The following information may be covered depending on the nature of the appointment.

• The patient will be reassured that based on current knowledge and the information available they are not at a high genetic risk, but may have an increased risk of developing cancer compared with the general near-population.
• The family history may be discussed, details checked, and the family tree (pedigree) extended if necessary.
• Information on the mechanism of the development of sporadic cancer and cancers with a genetic influence may be discussed. Information about the patient's specific family history of cancer will be explained.
• Patient management issues will be clarified. Depending on the family history, breast, ovarian or colorectal surveillance may be recommended. Health advice such as breast awareness may also be discussed.
• A clinical examination may be undertaken and details about the patient's medical history confirmed.
• The management of other family members may be discussed if appropriate. For example other members of the family may also need surveillance. An appointment can be offered to the relatives individually, or a copy of the clinic summary letter can be given to the appropriate relatives by the patient, which they can then take to their own GP who can arrange surveillance.
• If applicable DNA for storage ("banking") may needed. If the patient is agreeable, written consent must be obtained before the blood sample is taken (the blood sample can also be undertaken by phlebotomy services or at the GPs surgery). If blood for storage is required from a relative and they are willing, the mechanism for this will need to be arranged.
• The patient may have further questions that can be discussed.
• A summary letter and moderate risk information sheet can be sent to the patient following the appointment.
• Dependent on local arrangements and the family history, the patient may attend the surveillance unit for regular follow-up appointments.