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:-
- 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
- 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.