Who/where to refer

The NICE guidance stratifies the individual’s risk into near population, moderate and high risk.
Breast cancer risk category

Near population Moderate risk High risk *
Lifetime risk from age 20 Less than 17% Greater than 17% but less than 30% 30% or greater
Risk between ages 40 and 50 Less than 3% 3–8% Greater than 8%
* This group includes known BRCA1, BRCA2 and TP53 mutations and rare conditions that carry an increased risk of breast cancer such as Peutz-Jegher syndrome (STK11), Cowden (PTEN) and familial diffuse gastric cancer (E-Cadherin).

In Wales the management of breast conditions involves three complimentary services. For symptomatic women a referral to the local breast surgical service is appropriate. For routine screening Breast Test Wales operates a call recall service for women aged 50-70 and for high-risk women outside this age group, they also manage abnormal results from screening. For genetic counselling and, where appropriate, testing the Cancer Genetics Service for Wales has an all-Wales remit.

In order for a referral to be accepted the following criteria must be met:-

Breast cancer:-

  • 1 first degree relative diagnosed at 40 years or less
  • 2 first degree relatives or 1 first degree and 1 second degree relative on the same side of the family, diagnosed at 60 years or less
  • 3 first or second degree relatives on the same side of the family diagnosed at any age
  • 1 first degree male breast cancer
  • 1 first degree relative with bilateral breast cancer

N.B. breast cancer can be inherited through the paternal side of the family

Breast/ovarian cancer

  • Minimum: 1 of each cancer in first and second degree relatives (if only one of each cancer the breast cancer diagnosed under 50 years)
  • A first degree relative with both breast and ovarian cancer

First degree relatives: - Mother, Father, Daughter, Son, Sister, Brother

Second degree relatives: - Grandparent, Grandchild, Aunt, Uncle, Niece, Nephew, Half-Sister, Half-Brother

You can access a copy of the referral guidelines here.



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