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Family history (A/P-UN)

Individual with a family history of cancer from a family in whom a mutation in a cancer predisposition gene has NOT been identified (Adult and Paediatric Conditions in UNAFFECTED Patients)

Emergency referrals

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • No referrals to emergency relating to genetic testing or review

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • No Category 1 criteria

Category 2

Appointment within 90 days is desirable

  • Patients where the outcome of genetic counselling will influence planned surgery (e.g. whether or not bilateral salpingo-oophorectomy should be undertaken at the same time as a planned hysterectomy)
  • First or second degree relative of a patient with a CLINICAL diagnosis of a cancer predisposition syndrome in whom genetic testing has not been undertaken or was uninformative

Category 3

Appointment within 365 days is desirable

  • A patient with a family history of breast and/or ovarian cancer with at least one of the following:
    • Could be at potentially high risk of developing either breast or ovarian cancer according to the Cancer Australia Guidelines
    • fits in the high life time risk of breast cancer category according to FRA-BOC
    • fulfils criteria for the Medicare rebate for breast MRI
    • fits in the moderate (somewhat increased) or high (substantially increased) lifetime risk category according to iPrevent
    • have been referred by a specialist surgeon
    • first or second degree relative with ovarian cancer
  • A patient with a family history of colorectal and/or endometrial cancer with at least one of the following:
    • moderate or high lifetime risk of developing colorectal according to the NHMRC Guidelines
    • family history of three or more first or second-degree relatives with a Lynch syndrome-associated tumour or cancer, regardless of the age the cancers were diagnosed (further information can be found on the GHQ website)
    • reported family history of polyposis syndrome
    • family history of two or more first or second-degree relatives with colorectal or endometrial cancer, at least one of the cancers diagnosed at age < 50 years
  • A patient with a reported family history of a polyposis syndrome
  • A patient with a family history of gastric cancer with at least one of the following:
    • two or more first or second-degree relatives from the same side of the family with gastric cancer, at least one diagnosed at age < 50 years
    • three or more first or second -degree relatives from the same side of the family with gastric cancer, diagnosed at any age
    • family history of diffuse gastric cancer and cleft lip and/or palate
    • family history of GIST and paraganglioma or phaeochromocytoma
  • Next of kin of a deceased individual who is being referred to provide consent after genetic counselling for gene testing on stored DNA and/or tissue

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • The offer of an appointment by GHQ does NOT guarantee that the patient will be offered a publicly funded gene test.
  • If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene please refer to the Untested blood relative condition within the Genetics CPC
  • With rare exceptions, publicly funded genetic testing is NOT offered to individuals that are not personally affected by cancer (even if a family history of cancer is documented), when a mutation in a cancer predisposition gene has NOT first been identified in an affected family member.
  • GHQ will facilitate self-funded BRCA1 and BRCA2 gene testing for patients with a family history of breast and/or ovarian cancer who do not qualify for publicly funded gene testing and wish to pursue this option after genetic counselling.
  • Guidelines about prescribing the oral contraceptive pill (OCP) or hormone replacement therapy (HRT) for women with a family history of breast cancer can be found on the eviQ website.
  • Patients will be asked to provide detailed family information either during a telephone consultation (if urgent) or via a family history questionnaire (Cat 3). Failure to return the family history questionnaire prior to the appointment may result in removal of the patient from the waitlist.
  • One or more Consent to Release information forms may be provided to forward to family members to obtain their consent to confirm details of the reported family history.
  • Women aged 30-50 years who are at high lifetime risk of breast cancer and qualify for the Medicare rebate for breast MRI should be referred to a breast surgeon or familial breast cancer clinic at the same time as genetics referral.
  • If the patient has any living relatives with a personal history of cancer which meets GHQ referral guidelines, the relative could discuss a genetics referral with their treating doctor.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • As much detail as possible about the patient’s personal and family history including the following:
    • surveillance to date and the results of any related investigations (e.g. breast biopsies, polyps)
    • risk reducing surgery already undertaken
    • details of family history (type of cancer, age of diagnosis, relation to patient including whether maternal or paternal). For patients with a family history of breast cancer, referral must include sufficient details of family history to confirm eligibility for referral

Additional useful information (useful for processing the referral)

  • If the family is known to GHQ, include the GHQ reference number (GF) if known
  • Printout from iPrevent assessment (if available)
  • If the family are known to another genetic service and it is known, the name of the service and family reference number
  • Indicate if genetic testing has been undertaken in an affected family member and the results were uninformative or unknown to the referred patient.

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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