Proactive familial cancer risk assessment: A UK primary care study

Family-history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer-risk assessment is usually only offered to concerned individuals pro-actively self-presenting to their general practitioner, leading to inequity in accessing SPED in the community.To improve access to community cancer genetic risk assessment and explore barriers to uptake.Service development project of a digital pathway using the FHQS for cancer-risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG) METHODS: 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake.304/3100 (9.8%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, P<0.001), speak English as their main language (92% vs 76%, P<0.001) and not require an interpreter (99.6% vs 94.9%, P=0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family-history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral (N=23), genetics referral (N=15), and/or advice to relatives (N=18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details (N=26), losing the invitation (N=5), or forgetting (N=4).The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlights barriers to uptake requiring consideration to maximise impact and minimise inequity.