Why do women not return family history forms when referred to breast cancer genetics services? A mixed-method study

Background
Personal and family data forms, completed by women referred to breast cancer genetics clinics, are valuable tools for verification and extension of family history, crucial steps in accurate risk evaluation. A significant minority of women do not complete and return these forms, despite reminders, even when completion is a pre-requisite for a clinic appointment.

Objective
To facilitate access of women at increased familial risk of breast cancer to screening and counselling services by investigating reasons for non-return of the forms.
Participants and Design
Based on a single regional ‘breast cancer family’ service in the UK, Analysis of quantitative data comparing women who did not return forms (n = 55) with those who had done so (n = 59), together with qualitative evaluation of potential
barriers to form-completion through semi-structured telephone interviews with a random subset of ‘non-returners’ (n = 23).

Results
Non-returners have higher proportions of the very young (below the age at which surveillance could be offered) and of women from lower social deprivation categories. Interviews revealed that the majority of non-returners are anxious, rather than unconcerned about their breast cancer risk and circumstances and attitudes contributed to non-compliance. Twenty-one participants confirmed that they would welcome an appointment at a ‘breast cancer family’ clinic, but
nine did not attend for the appointment. They were significantly younger than those who attend, but were not at lower familial risk.

Discussion and Conclusions
Many women who fail to complete and return a family history form would benefit from risk assessment and genetic counselling. Several steps are suggested that might help them access the relevant services.