Objectives: To analyse spatial and temporal patterns in patients referred to a cancer genetics service in order to monitor service utilization and accessibility. Methods: Postcodes of patients during a 4-year period were used to examine spatial patterns using a Geographical Information System (GIS). Referral rates were compared visually and statistically to explore yearly variation for administrative areas in Wales. Results: There has been a four-fold increase in actual referrals to the service over the period of study. The variance between unitary authority referral rates has decreased from the inception of the service from an almost ten-fold difference between lowest and highest in year 1 to less than a three-fold difference in year 4. Conclusions: This study shows the potential of GIS to highlight spatial variations in referral rates across Wales. Although the disparity in referral rates has decreased, trends in referral rates are not consistent. Ongoing research will examine those referral and referrer characteristics affecting uptake.

Keywords:
Cancer genetics services, Wales, Geographical Information System
1.
Gray J, Brain K, Iredale R, Alderman J, France E, Hughes H: A pilot study of telegenetics. J Telemed Telecare 2000;6:245–247.
2.
Fry A, Campbell H, Gudmundsottir H, Rush R, Porteous M, Gorman D, Cull A: GPs’ views on their role in cancer genetics services and current practice. Fam Pract 1999;16:468–474.
3.
Lucassen A, Watson E, Harcourt J, Rose P, O’Grady J: Guidelines for referral to a regional genetics service: GPs respond by referring more appropriate cases. Fam Pract 2001;18:135–140.
4.
Calman K, Hine D: A Policy Framework for Commissioning Cancer Services. London, Department of Health, 1995.
5.
Working Group for the Chief Medical Officer: Genetics and cancer services. Report of a Working Group for the Chief Medical Officer, Department of Health. London, Department of Health, 1998.
6.
Starr J, Estes J: Geographic Information Systems: An Introduction. Englewood Cliffs, Prentice-Hall, 1990, pp 2–3.
7.
Boyle PJ, Kudlac H, Williams AJ: Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy. Q J Med 1996;89:151–157.
8.
Gatrell A, Garnett S, Rigby J, Maddocks A, Kirwan M: Uptake of screening for breast cancer in South Lancashire. Public Health 1998;112:297–301.
9.
Bentham G, Hinton J, Haynes R, Lovett A, Bestwick C: Factors affecting non-response to cervical cytology screening in Norfolk, England. Soc Sci Med 1995;40:131–135.
10.
Watson E, Clements A, Lucassen A, Yudkin P, Mackay J, Austoker J: Education improves general practictioner (GP) management of familial breast/ovarian cancer: Findings from a cluster randomised controlled trial. J Med Genet 2002;39:779–781.
11.
Watson E, Austoker J, Lucassen A: A study of GP referrals to a family cancer clinic for breast/ovarian cancer. Fam Pract 2001;18:131–134.
12.
Leeson S, Iredale R, Stansfield K, Evans A, Gray J: Developing a cancer genetics service in Wales: Opinions of gynaecologists on the management of women at risk of familial ovarian cancer. Eur J Cancer Care 2001;10:172–178.
13.
Elwyn G, Iredale R, Gray J: Reactions of GPs to a triage-controlled referral system for cancer genetics. Fam Pract 2002;19:65–71.
14.
Rose PW, Watson E, Yudkin P, Emery J, Murphy M, Fuller A, Lucassen A: Referral of patients with a family history of breast/ovarian cancer – GPs’ knowledge and expectations. Fam Pract 2001;18:487–490.
15.
Watson EK, Shickle D, Nadeem Q, Emery J, Austoker J: The ‘new genetics’ and primary care: GPs’ views on their role and their educational needs. Fam Pract 1999;16:420–425.
16.
Walter FM, Kinmoth AL, Hyland F, Murrell P, Marteau TM, Todd C: Experiences and expectations of the new genetics in relation to familial risk of breast cancer: A comparison of the views of GPs and practice nurses. Fam Pract 2001;18:491–494.
17.
Stansfield K, Iredale R, Leeson S, Evans A, Gray J: ‘In the family’: Experiences of general practitioners in Wales on the management of individuals at risk of familial cancer. Risk Management 2001;4:61–68.
18.
Women’s Concern Study Group: Raising concerns about family history of breast cancer in primary care consultations: Prospective, population based study. BMJ 2001;322:27–28.
19.
Wonderling D, Hopwood P, Cull A, Douglas F, Watson M, Burn J, McPherson K: A descriptive study of UK cancer genetics services: An emerging clinical response to the new genetics. Br J Cancer 2001;85:166–170.
20.
The Office for National Statistics (ONS). http://www.statistics.gov.uk.
© 2005 S. Karger AG, Basel
2005
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