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This monograph explores the spatial and temporal patterns of first referrals to the Cancer Genetics Service for Wales (CGSW) in order to establish what referral patterns exist. CGSW has a patient population of 10,878 first referrals over the eight year period 1998 to 2006. Nearly 70% are for breast, ovarian, or breast and ovarian cancer, which helps to explain why more than 90% of all referred patients are female. Referrals for high risk patients are more likely to come from secondary care rather than primary care and vice versa for those at medium risk. There is an inverse correlation between referrals and deprivation showing that as deprivation decreases, referrals increase. One temporal trend is an increase in referrals to the CGSW Swansea centre, and a corresponding decrease to the other two centres in Cardiff and Rhyl. These results have not produced any evidence that referral guidelines influence referrals. This research has identified cancer genetics as a field that needs to adopt policies aimed at reducing health inequalities and target resources at meeting unmet needs for cancer genetics services.

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Kevin McDonald is a Senior Lecturer in the Faculty of Health, Sport and Science at the University of Glamorgan, United Kingdom. He has responsibility for research teaching for pre- registration nursing students, and also teaches on post- registration and Masters courses. He is an active researcher in the Genomic Policy Research Unit.

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