CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Breast cancer - managing family history - Management
How do I assess a woman's risk of breast cancer and need for referral?
The following recommendations represent minimum criteria for referral. Locally-developed guidelines may be available and should be followed.
- If a faulty gene has been identified in the family, offer direct referral to a specialist genetics service (if the person has not already been seen by such a service).
- If there is no first- or second-degree maternal or paternal family history of breast cancer, manage in primary care by offering appropriate information and reassurance.
- If there is a first- or second-degree family history, but of only one relative who developed breast cancer after 40 years of age, manage in primary care.
- If there is a first- or second-degree family history of breast cancer affecting a relative 40 years of age or younger, or more than one relative:
- Offer referral to secondary care if the woman is likely to be at more than moderate risk of developing breast cancer (see Table 1).
- Otherwise:
- If the woman is likely to be at moderate risk (see Table 1), and the woman is 40–49 years of age, offer referral.
- If the woman is likely to be at moderate risk (see Table 1), but the woman is younger than 40–49 years of age, inform her that she will not generally be offered additional mammography. However, if she requests risk counselling/management or wants to be considered for prevention trials, seek advice from secondary care regarding her level of risk and whether referral is appropriate.
- If the woman is likely to be at less than moderate risk (see Table 1), manage in primary care.
- If the woman has a positive first- or second-degree family history and does not fulfil any of the above criteria for referral but there is a history of unusual cancers in the family (see Unusual cancers), there is a paternal history of breast cancer, or there is Jewish ancestry, seek advice from secondary care regarding her level of risk and whether referral is indicated.
- Consider referring, or discussing with secondary or tertiary care, those women who are particularly concerned about their risk of breast cancer but in whom it is impossible to assess risk accurately, such as:
- Where there is doubt over the diagnosis of breast cancer in their relatives or the age at which the cancer occurred.
- Those women with a small family (for example who have no sisters or aunts).
- Women who were adopted and do not know their family history.
Table 1. Referral criteria from primary to secondary care.
Women likely to be at more than moderate risk | Women likely to be at moderate risk |
|---|
Female breast cancers only One first-degree and one second-degree relative diagnosed at younger than an average of 50 years of age* Two first-degree relatives diagnosed at younger than an average of 50 years of age* Three or more first- or second-degree relatives diagnosed at any age | Female breast cancers only One first-degree relative diagnosed before 40 years of age One first-degree relative plus one second-degree relative diagnosed after 50 years of age Two first-degree relatives diagnosed after an average of 50 years of age* |
Male breast cancer One first-degree male relative diagnosed at any age |
Bilateral breast cancer One first-degree relative where the first primary was diagnosed at younger than 50 years of age. For bilateral breast cancer, each breast has the same count value as one relative |
Breast and ovarian cancer One first- or second-degree relative with ovarian cancer diagnosed at any age plus one first- or second-degree relative with breast cancer at any age (one should be a first-degree relative) |
*To calculate an average age, add the ages of all people together and divide by the number of people. |
© NHS Institute for Innovation and Improvement