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Cancer genetics: what role should the GP play?
The study by Leggatt et al on the use of a family history questionnaire by GPs to identify patients at high genetic risk of cancer (see item in Setpember 1999 Newsletter) has stimulated some correspondence in the BMJ. Emery questions whether primary care physicians should be actively seeking out individuals in this way, given that knowledge about genetic susceptibility is still very limited and the effectiveness of most preventive options is still unproven. In his view, GPs should be equipped to respond to patients' questions and worries if called upon, and should be able to make appropriate decisions about referral to a genetics centre, but should not be proactive in this area. In a second letter, Rose makes a similar point, stating "research should continue to ensure that services are implemented only when the benefits outweigh the risks, especially in the context of screening and case finding".
Comment: This correspondence highlights an important area of controversy. It should be kept in mind that the routine taking of family histories is in effect a screening measure, and can only be justified if appropriate interventions are available, based on the information. Such interventions are not available now, but they may be in the future, at which time a proactive role for GPs may be justified. If and when that time comes, lessons learned from research such as that of Leggatt et al may be called into play.