Familial Breast Cancer – Primary Care Management

Important messages to share with women with concerns:

  • Most women do not develop breast cancer, and of those who do, most will not have a known family history of the disease
  • For most women, increasing age is the greatest risk factor
  • The great majority of women with a family history of breast cancer do not fall into a high-risk category and do not develop breast cancer
  • The great majority of women with a relative with breast cancer are not at substantially increased risk of breast cancer themselves

Assessment

Signs and Symptoms

Faulty Genes

All relatives must be on same side of family and be blood relatives of the consultee and of each other.

  • First-degree relatives:
    • Mother
    • Father
    • Daughter
    • Son
    • Sister
    • Brother
  • Second-degree relatives:
    • Grandparent
    • Grandchild
    • Aunt
    • Uncle
    • Niece
    • Nephew
    • Half sister
    • Half brother
  • Paternal history:
    • Two or more relatives diagnosed with breast cancer on father's side of family

Management

Refer to tertiary care if a faulty gene has been identified.

Manage in Primary Care if:

  • No faulty gene identified
  • And No 1st and 2nd degree maternal or paternal family history show any breast cancer
  • There is only one relative diagnosed with breast cancer over age 40 and there are no unusual breast cancers in family/a paternal history of breast cancer/Jewish ancestry
    • Unusual cancers:
      • Bilateral breast cancer
      • Male breast cancer
      • Ovarian cancer
      • Glioma or childhood adrenal Cortical carcinoma
      • Sarcoma at younger than age 45 years
      • Complicated patterns of multiple cancers at young age
    • Paternal history:
      • Two or more relatives diagnosed with breast cancer on father's side of family
    • Jewish ancestry
      • Women with Jewish ancestry are around 5–10 times more likely to carry BRCA1 or BRCA2 mutations than women in non-Jewish populations

Seek advice from secondary care-contact about level of risk and appropriateness of referral if:

  • Is there only one relative diagnosed with breast cancer over age 40 and there are any unusual breast cancers in family/a paternal history of breast cancer/Jewish ancestry

Refer to Familial History clinic if:

  • No faulty gene identified

Referral

Referral Instructions

Referral using e-Referral Service:

  • Service: Surgery - Breast
  • Clinic type: FH of Breast Cancer (non 2WW)
  • Service: DRSS-Eastern-Surgery Breast- Devon CCG- 15N

Referral Forms

DRSS Referral forms

Supporting Information

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NHS Devon CCG.

Publication date: June 2017

 

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