Breast Cancer - Family History

🔍 When to Suspect

A patient presents with concerns about cases of breast, ovarian, or related cancers in their family, prompting a systematic risk assessment

From the full topic in The Ocean Library: Breast Cancer - Family History

🧭 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

---