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, while never letting 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, and how they are related. Risk is then classified into three bands that drive everything that follows.
| Risk category | Lifetime risk (from age 20) / 10-year risk (age 40–50) | What it means in practice |
|---|---|---|
| Near-population | < 17% / < 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% / 3–8% | Offer referral; enhanced surveillance (annual mammography 40–49) and a discussion of chemoprevention. |
| High | ≥ 30% / > 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) and familial diffuse gastric cancer (E-cadherin).
Source: NICE CG164 · NHS Breast Screening Programme
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