Referral

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
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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

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
      • Sarcoma at younger than age 45 years
      • Glioma or childhood adrenal cortical carcinoma
      • 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:

  • Usually referral only needed if two or more first or second degree relatives diagnosed with breast cancer over the age of 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 Instructions

Referral using the e-Referral Service:
Service: Surgery - Breast
Clinic type: FH of Breast Cancer (non 2WW)
Service: DRSS-Northern-Surgery Breast-Devon ICB- 15N

Referral Form

DRSS referral form

Patient Information

Breast Cancer Care

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: June 2017