Cancer Genetics Services in the UK

The National Health Service is the principal provider of free healthcare services, through general practitioners offering primary care to a network of District and Regional or University Teaching hospitals. Medical Genetics has a long history in the UK, although it was not recognised formally until the 1970s. Regional Genetics Centres, providing an integrated clinical and laboratory service, have been established for many years. Most also operate “outreach” clinics at satellite hospitals, or dedicated joint specialist clinics. There are 25 Regional Genetics Centres, each serving a population of 3–6 million: in 1997 they had 79 specialist clinicians (with 55 trainees), and 107 Genetic Counsellors. Genetic counselling is offered by Consultant Clinical Geneticists (with specialist training), supported by Specialist Registrars in Clinical Genetics and Genetic Nurses or Counsellors. Since the 1970s the UK has had several counsellors attached to each Regional Genetics Centre. In many centres they provide full genetic counselling for many conditions, with the support of a discussion departmental framework. Genetic Counsellors are valuable members of the clinical genetics team, who play a considerable role in the provision of counselling service, thereby reducing the workload of Consultants and Registrars, who can then target particular aspects of the service. Laboratory diagnostic services are integral parts of the Regional Genetics Centres. In 1997 there were 408 cytogeneticists (with 106 trainees) and 101 molecular geneticists (with 31 trainees). There is now a clear process of laboratory accreditation. The UK network of molecular genetics centres has rationalised testing for mutations in specific genes in certain centres only, by agreement. However, the patenting of genes such as BRCA1 and BRCA2 is likely to have a profound impact on the costs and management of cancer services, and could result in “rationing” of tests to very high-risk families only.