title: Inequality of use of cancer genetics services by members of breast, ovarian and colorectal cancer families in South East Scotland.
abstract: Some studies have found a deficiency of male, younger and more socially deprived individuals amongst referrals to and/or attendees at cancer genetics clinics. We investigated this inequality of use of genetics services from data on 4,178 Scottish patients with a family history of breast and/or ovarian cancer (BOC) or colorectal cancer (CRC) referred from 2000--2006. Some 98% BOC and 60% CRC referrals were female. Median age of female referrals was greater in the CRC than the BOC group (45.3 vs. 38.7 years, P < 0.001). Both groups of referrals were less socially deprived than the general population (P < 0.001) and the CRC less deprived than the BOC group (P < 0.001). Some 88% patients attended the first appointment offered. Attendance was greater in the CRC group (P < 0.001) and in older patients (P < 0.001) and in the BOC group was highly significantly lower in more socially deprived patients (P < 0.001). Male relatives may feel counselling is less relevant and relatives of both sexes may delay counselling until approaching the age of onset of cancer in a relative. We suggest that medical professionals and the general public may have more knowledge about the genetics of BOC than of CRC. Thus relatives in CRC families seeking counselling are likely to be those with access to more information. The lower attendance amongst more deprived relatives in BOC families may result from poor understanding of the reason for referral. These findings confirm the need to provide male, younger and more socially deprived relatives with more helpful information on cancer genetics.
authors.affiliation: Department of Clinical Genetics, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK. s.m.holloway@ed.ac.uk
authors.forename: Susan M
authors.initials: SM
authors.lastname: Holloway
authors.forename: Birgitta
authors.initials: B
authors.lastname: Bernhard
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.forename: Roseanne
authors.initials: R
authors.lastname: Cetnarskyj
authors.forename: Wayne W K
authors.initials: WW
authors.lastname: Lam
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics*; D015179:Colorectal Neoplasms / Q000235:genetics*; D005260:Female; D005817:Genetic Counseling / Q000706:statistics & numerical data*; D030342:Genetic Diseases, Inborn; D005820:Genetic Testing; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics*; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012307:Risk Factors; D012606:Scotland; D012959:Socioeconomic Factors