With a lifetime risk of around 12%, many families will have at least one woman affected by breast cancer. The NICE guidance describes the process that should be undertaken in primary care:-
- Do not actively seek to find persons with a family history of breast cancer
- First and second degree family history for those that present with concerns
- If clinically relevant take family history for those over 35 on combined OCP or considering HRT
- Second degree family history should include paternal and maternal relatives
- For referral decisions be as accurate as possible with:-
Age of diagnosis
Multiple cancers in an individual (including bilateral breast)
Jewish ancestry (5-10 x more likely to carry BRCA mutation)
NICE further suggest the information that should be given to all patients presenting with concerns:-
- Advice to return to discuss any implications if there is a change in family history or breast symptoms develop.
- Standard written information for all people which includes:-
- Risk information about population level and family history levels of risk, including a definition of family history.
- The message that, if their family history alters, their risk may alter.
- Breast awareness information.
- Lifestyle advice regarding breast cancer risk, including information about:
- HRT and oral contraceptives
- lifestyle, including diet, alcohol, etc
- breastfeeding, family size and timing
- Contact details of those providing support and information, including local and national support groups.
- People should be informed prior to appointments that they can bring a family member/friend with them to appointments.
- Details of any trials or studies that may be appropriate.
This written information is covered in full by the NICE publication “Familial Breast Cancer, information for the public”
GPs in Wales should be aware that the NICE guidance recommends MRI screening for younger age groups, this is not available in Wales.