Breast and ovarian cancer

Patients with a family history of breast and/or ovarian cancer – who should you refer?

NICE Guidelines

https://www.nice.org.uk/guidance/cg164/chapter/Recommendations#clinical-significance-of-a-family-history-of-breast-cancer

Summary of points 1.3.3. and 1.3.4 of the guidelines

Referral from primary care

1.3.3

People without a personal history of breast cancer who meet the following criteria should be offered referral to secondary care:

  • one first-degree female relative diagnosed with breast cancer at younger than age 40 years or
  • one first-degree male relative diagnosed with breast cancer at any age or
  • one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years or
  • two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age or
  • one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative) or
  • three first-degree or second-degree relatives diagnosed with breast cancer at any age. [2004]

1.3.4

Advice should be sought from the designated secondary care contact if any of the following are present in the family history in addition to breast cancers in relatives not fulfilling the above criteria:

  • 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 (two or more relatives on the father’s side of the family). [2004]