Family history of breast cancer

High risk group

Breast, breast/ovarian families with four or more relatives on the same side of the family.
Breast cancer only families with three affected relatives with an average age of diagnosis of 40 or less or ages 40-50.
Breast/ovarian cancer families where the breast ca has occurred at or less than age 50 and ovarian ca at any age.
Families with one member with both breast and ovarian cancer.
Rare syndromes:
- Li Fraumeni (breast cancer younger than 40, sarcoma, childhood tumours: not necessarily all of these appear in one family).
- Cowden syndrome: benign breast disease, breast ca, thyroid goitre, thyroid ca.

Maybe high risk so need assessment by genetics

Three 1st or 2nd degree relatives with breast or ovarian cancer diagnosed at any age on the same side of the family. Family structure influences assessment.
One 1st degree female relative with breast cancer diagnosed under 40 or one male 1st degree relative with breast cancer.

All families who are thought to be high risk should be assessed by the Genetics Department by letter or by consultation. The RVI combined family history clinic has a genetics presence so is included.

The recommended screening is annual examination by a breast surgeon from age 35 or 5 years younger than youngest affected family member until age 50. Annual mammography should not start before 35 and commencing age is dependent on age of affected relatives. The age when mammograms start should be 5 years younger than youngest affected family member with 35 as a cut-off below which mammography should not be offered as screening. From age 50 these women move into the National Breast Screening Programme. The only exception being those women who have a BRCA1 or BRCA2 mutation or are at 50% risk of carrying one. These women should continue to be followed up on an annual basis in the relevant breast clinic until age 65.

Moderate risk group

Two 1st or 2nd degree relatives with breast cancer diagnosed under age 50 or one with breast cancer under 60 and one with ovarian cancer at any age.
3 relatives with breast ca with ages 50-60.
A 1st degree relative with bilateral breast cancer.
Women initially assessed at high risk who have a lower risk on the basis of family structure.

The recommended screening is annual mammography from 5 years younger than the youngest relative (but not below the age of 35) to age 50 and then entry into the National Breast Screening Programme.

Low Risk Group

Any women with a less marked family history than those described above. These women should be reassured regarding their low risk status.

Family History of Breast Cancer "Relative" includes first degree relative and their first degree relatives (first degree relatives - mother, father, brother sister, child). A relative with clearly bilateral breast cancer can be viewed as two relatives for simplicity. A male relative with breast cancer counts as a young female (< 40)		Expected breast cancer cases between 40-50yrs Population risk for breast cancer age 40 to 50 is 1 in 100 (1%), risks expressed as 1:n meaning 1 in every ‘n’ women with a similar family history would be expected to get breast cancer.	Lifetime relative risk Population lifetime risk (age 20-80) years is 1 in 11 (9%).	Risk group Risk category: Low risk <2 x population lifetime risk. Moderate 2-3 x population lifetime risk. High 3 x lifetime population risk.	Early mammography Early screening mammography should start not younger than 35 years of age in the moderate risk group, the risk of cancer and potential benefits of screening are most likely to be seen in the 40-50 year age group.	Specialist genetics clinic to be assessed with a view to genetic mutation analysis and more formal risk estimation.
1 relative	1 relative < 40yrs	Maximum 1:50	Maximum 1:8	Low	No	No
1 relative	1 relative < 40yrs female < 30 or male affected at any age	1:30 - 1:50 maximum 1:25	1:12 - 1:6 maximum 1:6	Low/moderate	Yes	No Ethnic origin may make mutation searching easier for example Ashkenazi Jewish ancestry might mean genetic tasting would be more helpful even with a less striking family history.
2 relatives	2 relatives 50-60 yrs	1:40	1:8	Low	No	No
	2 relatives average age 40-49	1:25	1:6 - 1:4	Moderate	Yes	No Ethnic origin may make mutation searching easier for example Ashkenazi Jewish ancestry might mean genetic tasting would be more helpful even with a less striking family history.
	2 relatives average age 30-39	1:14	1:4 -1:3	High	Yes	Yes
3 relatives	3 relatives average age 50-60	1:15	1:4	Moderate	Yes	Yes
3 relatives	3 relatives average age 40-50	1:11	1:3	High	Yes	Yes
Breast and other cancers	1 or more relative with < breast cancer 50 years + ³ 1 relative with ovarian cancer at any age OR one relative with both	Usually more than 1:25	Usually more than 1:6	Moderate/high	Yes	Yes
Breast and other cancers	1 or more relative with breast cancer < 40 years plus relative with childhood malignancy			May be high	Avoid mammograms pending genetics review	Yes

NHS Executive interim advice to GPs on familial breast cancer

Source: Dr L. McLean, breast Screening and Assessment Centre, Newcastle, November 1999.