Most countries now have services for familial cancer genetics, but these vary considerably (Harris, 1998; Hodgson et al., 2000). There are, broadly, three potential approaches for developing a clinical service in response to the growing evidence of the links between inherited genetic factors and the risks of developing breast and ovarian cancers:

1. An ad hoc system of providing advice to patients, i.e. ‘demand led’

2. The development of a selective system of screening patients who are estimated to be at relatively high genetic risk of developing these cancers

3. The establishment of systems of population screening to identify patients at increased risk

Over the last few years, many clinics worldwide have been providing advice to patients with a family history of cancer through clinics in an ad hoc and uncoordinated manner, funded largely through ‘soft money’. The resources available have not kept pace with the rapid growth in demand, and this is reflected in the sharp increase in waiting times for appointments in recent years.

Only 5% of breast and ovarian cancers are thought to be due to a strong inherited susceptibility. A process of selection of individuals who are estimated to be at high risk on the basis of their family history for screening for cancer is a more pragmatic approach than screening the general population. However, it is important to demonstrate clearly the benefit of such surveillance programmes before this can be advocated on a large scale (Scottish Office Home and Health Department, 1998).