Family history of breast cancer

Definition/Description

Asymptomatic woman with family history of breast cancer.

Red Flag Symptoms

Palpable breast lump.
Any unilateral changes in skin, nipple or nipple discharge.
These require assessment and referral along appropriate pathways.

Guidelines on Management

Take first- and second-degree family history.

Use of FH questionnaire will help to gather information about age, site of tumours, bilateral tumours or Ashkenazi Jew heritage.

Use the 2017 Family History Questionnaire to assess the risk in primary care and, if referral to secondary care is indicated, to provide all the detail the specialists need to effectively prioritise patients.

Generally, the NICE guidance criteria for a further assessment in the Family History of Breast Cancer Clinic are:

One first degree relative with breast cancer at < 40 years old.
One first degree male relative with breast cancer at any age.
One first degree relative with bilateral breast cancer where the first cancer was
diagnosed at <50 years old.
Two first degree or one first degree and one second degree relative diagnosed
with breast cancer at any age.
One first degree or second relative with breast cancer at any age plus one first or second Degree relative with ovarian cancer at any age (one of these should be a first degree relative).
Three first or second-degree relatives on the same side of the family with breast
cancer at any age.
If more than one relative is involved, they should be on the same side of the family.

Women who do NOT meet the above criteria can be reassured that their risk of breast cancer is near to that of the general population. Advise breast awareness and to report any new diagnoses within the family.

Do not refer

None

Referral Criteria/Information

Those meeting the above criteria should be referred to the Family History Clinic. ENSURE a completed FH questionnaire accompanies referral.

Other Considerations

If the above criteria are not met re FH of breast cancer- consider discussion with secondary care or referral to genetics if there is history of the following:

bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (2 or more relatives on the father's side of the family)