Cost of Family History Clinic in a District General Hospital

The aim of this study was to review the financial costs of the Family History Clinic (FHC) in a Distric General Hospital (DGH), which offered women at moderate to high risk of familial breast cancer risk assessment, regular clinical and radiological screening according to local guidelines and protocols. The clinical record of all the patients attending a FHC in a DGH were reviewed for patient characteristics, strength of family history, number and cost of clinical visits, radiological and cytological examinations. The 79 patients in the family history follow-up clinic 32 (41%) were high risk, 46 (58%) were moderate risk and in one patient (1%) the clinical records were incomplete. The mean Claus score lifetime risk of familial cancer was 26(9). At a mean follow up of 4 years and after an expenditure of 68,225, only one mammographically occult grade II, node positive (3/16) interval cancer was detected in a woman from the high-risk group; no cancer was detected at the prevalent or incidental screening round. The average (standard deviation) outpatient cost of the FHC per patient was 870 (480). The average cost of attendance at a family history clinic was approximately 218/ patient/year. Significant clinical and radiological resources used to run a FHC in a DGH failed to yield early detection of breast cancer in a cohort of moderate and high-risk patients. The provision of a service of FHC outside Clinical Trial settings is difficult to justify.