Author's objectives
This report provides guidelines on the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care.
Author's conclusions
Key priorities for implementation
Approaches to care:
1. Effective care involves a balanced partnership between patients and healthcare professionals. Patients should have the opportunity to make informed choices about any treatment and care and to share in decision making.
2. To ensure a patient-professional partnership, patients should be offered individually tailored information, including information about sources of support (including local and national organisations).
3. Standard written information regarding familial risk and breast cancer risk factors should be developed for use in primary, secondary and tertiary care, to provide consistent advice to women.
Family history and referral:
4. When a woman presents with breast symptoms or has concerns about relatives with breast cancer, a first- and second-degree family history should be taken in primary care to assess risk, because this allows appropriate classification and care.
5. Healthcare professionals should respond to women who present with concerns, but should not, in most instances, actively seek to identify women with a family history of breast cancer.
6. Local protocols for the care of women at risk of familial breast cancer should be developed with clear referral mechanisms between primary, secondary and tertiary care, and with appropriate facilities.
Care:
7. Access to psychological support and assessment is a key part of the package of care needed for many women covered by this guideline.
8. All women aged 4049 years satisfying referral criteria to secondary or specialist care (at moderate risk or greater) should be offered annual mammographic surveillance.
9. Mammographic surveillance should only be undertaken after provision of information about its potential advantages and disadvantages for the early detection of breast cancer, and where offered, this should be of high quality (equivalent to NHS Breast Screening Programme standard) and audited.
10. Genetic testing is appropriate only for a small proportion of women who are from high-risk families.
11. Risk-reducing surgery (mastectomy and/or oophorectomy) is appropriate only for a small proportion of women who are from high-risk families and should be managed by a multidisciplinary team.
Important messages to share with women with concerns:
Most women do not develop breast cancer, and of those who do, most will not have a known family history of the disease.
For most women, increasing age is the greatest risk factor.
The great majority of women with a family history of breast cancer do not fall into a high-risk category and do not develop breast cancer.
The great majority of women with a relative with breast cancer are not at substantially increased risk of breast cancer themselves.
Bibliographic details
National Institute for Clinical Excellence. Familial breast cancer: the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care. National Institute for Clinical Excellence (NICE), 2004; Clinical Guideline 14: 40
URL of original report
http://www.nice.org.uk/page.aspx?o=203181
Status
The HTA database is produced by the Centre for Reviews and Dissemination (CRD), York and the International Network of Agencies for Health Technology Assessment (INAHTA), Sweden. The HTA database contains information on publications and projects from nationally funded health technology assessment organisations. The abstracts in this database are descriptive only, and the original reports have not been evaluated by reviewers from the CRD
