title: Analysis of referrals to a multi-disciplinary breast cancer genetics clinic: practical and economic considerations.
abstract: Analysis of activity was undertaken in an established regional clinic providing risk assessment, counselling, screening and management for women with a family history of breast or ovarian cancer. The objectives were to determine: (1) how closely the route and pattern of referrals matched official guidelines (2) whether the previously recorded socio-economic imbalance among clinic clientele persisted and (3) the economic and practical consequences of committing resources to verification and extension of reported family histories. The findings were: (1) after some years of operation, the proportion of referrals direct from primary care had increased from less than 50% to over 75%, with a concomitant slight decrease in overall referral rate; (2) the socio-economic distribution of patients referred had become less selective and (3) extension and verification of reported family histories led to a redistribution of risk categories, increasing the proportion of referrals judged to be in the "low risk" category, from 25% (based on referral letter alone) to 41% (at the end of the process). The costs associated with this approach are offset by the savings generated and it allows specialised counselling and screening services to be targeted more efficiently.
authors.affiliation: Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: Marta M
authors.initials: MM
authors.lastname: Reis
authors.forename: Dorothy
authors.initials: D
authors.lastname: Young
authors.forename: Lorna
authors.initials: L
authors.lastname: McLeish
authors.forename: David
authors.initials: D
authors.lastname: Goudie
authors.forename: Alan
authors.initials: A
authors.lastname: Cook
authors.forename: Frank
authors.initials: F
authors.lastname: Sullivan
authors.forename: Helen
authors.initials: H
authors.lastname: Vysny
authors.forename: Alison
authors.initials: A
authors.lastname: Fordyce
authors.forename: Roger
authors.initials: R
authors.lastname: Black
authors.forename: Manouche
authors.initials: M
authors.lastname: Tavakoli
authors.forename: Michael
authors.initials: M
authors.lastname: Steel
mesh_terms: D001943:Breast Neoplasms / Q000191:economics / Q000235:genetics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D012017:Referral and Consultation; D018570:Risk Assessment