GPAtlas🧭 When to suspect
Around 1 in 7 women in the UK will develop breast cancer, and most cases are sporadic – but a minority arise in families carrying a strong inherited predisposition.
The primary-care task is rarely to diagnose: it is to take an accurate family history, stratify risk, and refer the right people by the right route.
Never let a family-history conversation eclipse a breast symptom that needs the suspected-cancer pathway.
A family history is usually explored when a patient raises concerns or presents with breast symptoms, though there is growing emphasis on identifying increased risk proactively.
Take a first- and second-degree family history on both the maternal and paternal sides, recording for every affected relative:
• Which cancer they had.
• Their age at diagnosis.
• How they are related.
Risk is then classified into three bands that drive everything that follows.
| Risk category | Lifetime risk (from age 20) and 10-year risk (age 40–50) | What it means in practice |
|---|---|---|
| Near-population | < 17% and < 3% | • Most people with a single older-onset relative • Manage in primary care – breast awareness, lifestyle advice, routine NHS screening from 50 |
| Moderate | 17–30% and 3–8% | • Offer referral • Enhanced surveillance (annual mammography 40–49) and a discussion of chemoprevention |
| High | ≥ 30% and > 8% – or a known BRCA1, BRCA2 or TP53 mutation | • Refer (directly to genetics if a gene is already known) • Mammography ± MRI surveillance • Chemoprevention and risk-reducing surgery options |
A subset of the high-risk group – those with a lifetime risk of 40% or more because of a known genetic abnormality – is eligible for the NHS Breast Screening Programme’s very-high-risk surveillance pathway.
The high-risk band also includes rare syndromes such as:
• Peutz–Jeghers (STK11).
• Cowden (PTEN).
• Familial diffuse gastric cancer (E-cadherin).
Source: NICE CG164 · NHS Breast Screening Programme
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.