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 department 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 clinical genetics

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

A relative of an individual with a hematological malignancy who is a matched donor for a planned allogenic stem cell transplant.

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
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 their referral was recommended after review of a relative

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:
- fits in the or high (substantially increased) lifetime risk category according to iPrevent, Tyrer-Cuzick or CanRisk
- Two first degree or second degree relatives on one side of the family diagnosed with breast or ovarian cancer plus one or more of the following features on the same side of the family:
  - additional first degree or second degree relative(s) with breast or ovarian cancer, breast cancer diagnosed before the age of 40, bilateral breast cancer, breast and ovarian cancer in the same women, Jewish ancestry, breast cancer in a male relative
- first degree relative with ovarian cancer
A patient with a family history of colorectal and/or endometrial cancer with at least one of the following:
- 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 patient’s 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
A patient with a family history of pancreatic cancer and one of the following:
- at least two first degree relatives with pancreatic cancer
- three or more relatives with pancreatic cancer, at least one of whom is a first degree relative
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 Genetic Health Queensland (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.
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 mailed a family history questionnaire to complete and return. Failure to do so may result in removal of the patient from the waitlist.
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.
Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

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 and/or printout of an iPrevent assessment attached to the referral
- Confirmation of OOHC (where appropriate) and contact details to send correspondence for OOHC

Additional useful information (useful for processing the referral)

If the family is known to GHQ, include the GHQ reference number (GF) if known
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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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

Clinical Information (essential)

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