Refer to Beds & Herts Breast Cancer Family History Screening service Family History of Breast Cancer Management Summary L & D Logo Patient presents with a family history of breast and/or ovarian cancer Assess Family History Low Risk Medium to High Risk Manage in Primary Care Refer to Beds & Herts Breast Cancer Family History Screening service Reassure Advise on Breast Awareness Advise to report any symptoms or changes in family history promptly Advise on participation in National Breast Screening Programme from age 50. Detailed risk assessment and discussion of options according to level of risk Completion of detailed questionnaire about family History Annual mammography for those aged 40 - 49 If appropriate refer for Genetic Counselling Participation in research studies Please note that there is no strong evidence yet available regarding the effectiveness of current management options, it is generally believed to be inappropriate to actively search for such cases at this time. It is, however, important to respond consistently to those who seek information.

Beds & Herts Breast Cancer Family History Screening service Referral Guidelines L & D Logo ? Currently, females aged between 47 – 73 are managed by the national database for the National Breast Screening Programme. NICE Guidelines suggest that patients with a medium to high risk of breast cancer require regular follow up from the age of 40, until they reach the national breast screening program. The purpose of these guidelines is to assist GP’s in identifying those individuals who are at an increased risk of developing breast and/or ovarian cancer and who may therefore benefit from referral for further assessment. If a patients family history fits within ANY of the criteria listed below, then this MAY indicate a higher risk of developing breast and/or ovarian cancer, and the patient may benefit from referral for a more detailed assessment. If you are unsure about whether or not to refer and individual, please contact the Beds & Herts Breast Cancer Family History Screening Service for further advice. IT IS IMPORTANT TO REMEMBER THAT THESE ARE SIMPLY GUIDELINES AND THAT SOME OF THE PATIENTS WHO FIT THE REFERRAL CRITERIA WILL BE CONSIDERED LOW RISK FOLLOWING FURTHER ASSESSMENT. Is there at least one of the following present in the family history? Female breast cancers only One 1st degree relative and one 2nd degree relative diagnosed before average age of 50 Two or more 1st degree relatives diagnosed at any age Male breast cancer One 1st degree male relative diagnosed at any age Bilateral breast cancer One 1st degree relative where 1st primary diagnosed before the age of 50 For Bilateral breast cancer, each breast has the same count value as one relative Breast and ovarian cancer One 1st or 2nd degree relative with ovarian cancer at any age AND one 1st or 2nd degree relative with breast cancer at any age (one should be a first degree relative) Is there at least one of the following present in the family history? Female breast cancers only One 1st relative diagnosed before average age of 40 One 1st degree and one 2nd degree relative diagnosed after the age of 50 One 1st degree relative and one 2nd degree relative diagnosed after average the age of 50