Buying health services for local people

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Breast cancer (family history) – Information for GPs

Referral criteria / commissioning position

Refer for further assessment to the Family History Clinic if:

  • Patient is between 35 - 50 years old.
  • Patients who fall outside of this age range – please call the service for Advice & Guidance
  • one first degree relative with breast cancer at <40 years old
  • one first degree male relative with breast cancer at any age
  • one first degree relative with bilateral breast cancer where the first cancer was diagnosed at <50 years old
  • two first degree or one first degree and one second degree relative diagnosed with breast cancer at any age
  • one first degree or second relative with breast cancer at any age plus one first or second degree relative with ovarian cancer at any age (one of these should be a first degree relative)
  • three first or second degree relatives on the same side of the family with breast cancer at any age
  • if more than one relative is involved they should be on the same side of the family

Use the 2017 Family History Questionnaire to assess the risk in primary care and, if referral to secondary care is indicated, to provide all the detail the specialists need to effectively prioritise patients.

Women not meeting these criteria can be reassured – they are at or near the general population risk.

Advise breast awareness and report new symptoms.

Red flag symptoms

  • Palpable mass in breast
  • Breast ulceration, skin distortion or nodule, persisting nipple eczema, unilateral blood stained discharge or recent nipple retraction

Investigations prior to referral


Information to include in referral letter

  • Details of how this patient meets this criteria
  • Relevant past medical/surgical history
  • Drug history (prescribed and non-prescribed)
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

References and additional information

Patient information


NICE Guideline 164 (2013) Familial Breast Cancer

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