Tozer Debbie, Lugton Cameron
Public Health Department, Somerset PCT, Wynford House, Lufton Way, Lufton, Yeovil, Somerset, BA22 8HR, UK.
Fam Cancer. 2007;6(2):221-9. doi: 10.1007/s10689-007-9133-0. Epub 2007 May 23.
Somerset has a relatively high incidence of cancer. The county is very rural with pockets of deprivation and sizeable areas of poor access to services. The Cancer Plan advocates early identification of cancer and identified the genetic revolution as having the potential to predict risk, and detect and diagnose cancer early. This innovative Public Health led pilot takes specialist cancer genetics services into primary care. It explores a new service model that is patient focused, provides services close to home and reduces hospital visits and pressure on genetics departments. People who believe they are at increased risk of developing cancer, due to family history, are assessed by nurse specialists at their local surgery and triaged into population, medium and high risk groups. Patient pathways have been streamlined for breast, ovarian and colorectal cancers, which are known to have a genetic link and there may be advantage in increased surveillance and/or genetic testing. People are given the opportunity to understand their personal level of risk and make choices about lifestyles and interventions. To support the delivery of cancer genetics services in primary care a bespoke software package has been developed building on a commercial programme already established in many genetics departments. Electronic transmission of pedigrees from primary to tertiary care assists the lean pathways and the incorporation of a new risk calculator based on NICE guidelines for familial breast cancer is being assessed.
萨默塞特郡的癌症发病率相对较高。该郡以乡村为主，存在贫困地区，且有相当大的区域难以获得医疗服务。《癌症计划》倡导早期发现癌症，并认为基因革命有潜力预测风险、早期检测和诊断癌症。这项由公共卫生部门主导的创新试点项目将专业的癌症基因服务引入初级医疗保健。它探索了一种以患者为中心的新服务模式，在离家近的地方提供服务，减少医院就诊次数以及减轻基因科室的压力。因家族病史而认为自己患癌风险增加的人，由当地诊所的护士专家进行评估，并被分为低风险、中风险和高风险人群。针对已知存在基因关联的乳腺癌、卵巢癌和结直肠癌，简化了患者就医流程，加强监测和/或基因检测可能会有好处。人们有机会了解自己的个人风险水平，并对生活方式和干预措施做出选择。为支持在初级医疗保健中提供癌症基因服务，在许多基因科室已采用的一个商业程序基础上开发了一个定制软件包。从初级医疗保健向三级医疗保健电子传输家系图有助于简化流程，目前正在评估纳入基于英国国家卫生与临床优化研究所（NICE）家族性乳腺癌指南的新风险计算器。
