Family history of breast cancer

 

Familial breast cancer occurs in women with more family members with breast or related cancers than would have been expected by chance alone. It may be that members of such a family carry genes that contribute towards the development of breast cancer.  Early onset, a high incidence of bilateral disease, and an association with other malignancies (such as ovarian cancer) usually characterize breast cancer due to mutations of specific genes (hereditary breast cancer).  Most women will never develop breast cancer and most of those who do will not have familial breast cancer. As one in 8–10 women will develop breast cancer during their lifetime, many people have a relative with breast cancer, but this may be due to chance rather than to genetic or shared lifestyle factors.  It is important to remember that most women with a family history of breast cancer are not at a substantially increased risk of breast cancer

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Assessment

Asymptomatic patient presenting with a family history of breast cancer:

  • Take first and second degree family history to assess risk, being as specific as possible on:
    • age at diagnosis
    • site of tumour
    • multiple cancers (including bilateral disease)
    • Jewish ancestry

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Referral criteria

Patients with the following criteria will be accepted:

  • one first degree relative with breast cancer at < 40 years olds
  • 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 < 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 one second degree 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

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NOTE Women not meeting these criteria can be reassured, advised about breast awareness and to report any breast symptoms - they are at or near the general population risk

Patients fulfilling the above criteria can be referred to the Family History Breast Cancer Assessment Clinic at The Kent and Canterbury Hospital

Guy’s and St Thomas’s Hereditary cancer risk assessment and referral guidance for clinicians can be accessed here

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Information to include on referral letter

Include the following information when making a referral:

  • Any other cancer history within the family
  • Availability of affected family member for genetic testing if indicated

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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