A wide range of mutations has already been detected but we do not know the significance of these for the pathogenesis of disease. The taking of a family history in a primary care setting is a first screening test, but even this constitutues an intervention and should be subject to audit. Where there is uncertainty, it is important that national guidance should be available. It is unreasonable to expect local health authorities to make informed decisions. This will have as part of its brief advice on screening for genetic diseases.
Consumer protection is an important role for public health.
Media hype is almost inevitable and this creates unreasonable expectations. Information, including risk assessment is beginning to be available on the internet and this will increase. There is a danger of psychological damage from such uncontrolled sources. When challenged to provide advice to local health authorities on the management of familial breast cancer the meeting suggested that it was important to provide joint clinics with specialist surgeon, oncologist, nurse, etc and to provide guidelines on referral for GPs. It was also important to improve the dialogue between primary and secondary care.