Who/where to refer

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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