Family history screening

Background
Breast cancer is a common disease. Not all women who have a relative with breast cancer have an increased risk of developing breast cancer themselves but some do and it is important that these women are given appropriate increased screening.

The indicators for increased risk are complex. The likelihood that a women’s risk is increased depends very much on which relatives have had breast cancer and at what age they were diagnosed.

NHS guidelines recommend that the NHSBSP should now be responsible for the screening of women who have a Very High Risk of developing breast cancer due to their family history.

A designated Family History Clinic commenced at the Breast Screening Centre Luton and Dunstable Hospital in April 2012.

If you think you may be at increased risk of developing breast cancer due to breast cancer having been detected in close members of your family you must discuss this with your GP.

The majority of women who do have a family history of breast cancer do not fall into a high risk category. (Nice Guidelines 2018).

The majority of women that have a relative who has or has had breast cancer are not at a substantially increased risk themselves. (Nice Guidelines 2018).

Those women referred to the Family History Clinic will be sent a questionnaire to complete and return. The details provided in this questionnaire will be used to calculate the individual risk of breast cancer.

Those found to be at moderate risk are invited for annual screening from age 40-50 or 40-60 depending on their calculated risk.

Those women thought to be at high risk because a gene mutation has been found in a family member are referred to the specialist genetic service by their GP. Those found to have a gene mutation are then offered annual mammograms and in some cases also annual MRI.

Management of women in our Family History Clinic.

New Patients

New family history patients found to be at increased risk after referral by their GP will be offered an appointment at the Breast Screening Centre. They will be counselled by a Breast Physician/Family History Nurse prior to their first mammogram. Ongoing surveillance will be planned according to the individual’s level of risk. Results of the mammograms will be sent at a later date.

If any abnormal features are seen on the mammograms, the individual will be invited to return for an assessment appointment with a clinician at the Beds & Herts Breast Screening Centre for further investigation, which could include additional x-rays, an ultrasound and possibly biopsies.

Some women at the age of 50 will join the National Breast Screening Programme, whilst those at a calculated higher risk will continue to have annual mammograms until the age of 60.

If women are significantly under 40 at the time of risk assessment and do fit the criteria for enhanced screening at the age of 40, then we would ask them to be re-referred by their GP closer to their 40th birthday. If the risk for women is calculated as Population risk, then they will be informed by letter only.

The majority of women that have a relative who has or has had breast cancer are not at a substantially increased risk themselves. (Nice Guidelines 2018).