Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions - Introduction

The current organisation of specialist genetics services within the NHS reflects their historical evolution. They have developed from academic departments to regional centres, each of which serves a number of smaller districts and usually has integrated clinical and laboratory services.(1) Until the late 1980s, UK genetics services were concerned in the main with the diagnosis of fairly uncommon congenital and inherited disorders, and counselling generally concerned reproductive issues.(2) For many years, genetic counselling has been provided almost exclusively by physicians, with the introduction of genetic counsellors or associates with a science or nursing background a fairly recent development.(3,4) Clinical genetics services have therefore had limited capacity to deal with the increasing demand which resulted from the rapid expansion of molecular genetics knowledge.(2) New ways of dealing with patient demand have been suggested; for example, an increased role for GPs,(2,5-7) supported by guidelines(8) and computer support aids,(9,10) the introduction of intermediate levels of specialist advice(2,11) and an enhanced role for nurses.(2-4,12)