Referrals to genetics departments for evaluation of genetic cancer susceptibility are increasing rapidly in all countries, particularly those with higher socioeconomic levels, and efficient and effective management of these referrals is paramount. Evaluation of the cost effectiveness of such services is vital, both for the geneticists developing them, and for the wider Health Service planners and Departments of Health. Thus, service development requires a partnership between clinicians, service providers and purchasers, and health planners. The drive behind the increase in demand for services is a combination of increase in scientific knowledge about cancer genetics, and the rapidly increasing public appreciation of this, and its potential impact on cancer prevention. Such developments are likely to be greatest in countries with a high general standard of living and health care. In less well developed countries, such a cancer genetics service, whose benefits have not yet been clearly shown, may be considered a barely affordable luxury. In the current situation, where the service has been developed more in some countries than others, it seems prudent for the experience of the countries where services are further advanced to be passed on to countries just initiating them. The identification of factors impeding their development may be helpful, and observing how different countries approach the problem and overcome obstacles may be instructive. To this end, we have documented the current cancer genetics service provision in different European countries and related this to their economic, political, and general health care backgrounds. The development of services within Europe is occurring in parallel with those in the United States and Australia.

In the United States, a national network of cancer genetics services was proposed by the National Institutes of Health in 1996. …