Proactive familial cancer risk assessment: a service development study in UK primary care.

Background: Family history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention, and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer risk assessment is usually only offered to concerned individuals proactively self-presenting to their GP, leading to inequity in accessing SPED in the community.

Aim: To improve access to community cancer genetic risk assessment and explore barriers to uptake.

Design & Setting: Service development project of a digital pathway using the FHQS for cancer risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG).

Method: 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake.

Results: In total, = 304/3100 (10%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, <0.001), speak English as their main language (92% vs 76%, <0.001), and not require an interpreter (99.6% vs 94.9%, = 0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral ( = 23), genetics referral ( = 15), and/or advice to relatives (n = 18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details ( = 26), losing the invitation ( = 5), or forgetting ( = 4).

Conclusion: The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlighted barriers to uptake requiring consideration to maximise impact and minimise inequity.