FAMILIAL BREAST CANCER GUIDELINES- PRIMARY CARE
Southend University hospital Breast Unit runs a dedicated family history clinic for secondary care referrals. Mr Thomas sees family history patients privately at Spire Wellesley hospital.
1.3 Care of people in primary care
Care and management in primary care1.3.1 People without a personal history of breast cancer can be cared for in primary care if the family history shows only one first-degree or second-degree relative diagnosed with breast cancer at older than age 40 years[4], provided that none of the following are present in the family history:
Referral from primary care1.3.3 People without a personal history of breast cancer who meet the following criteria should be offered referral to secondary care:
1.3.6 Direct referral to a specialist genetics service should take place where a high-risk predisposing gene mutation has been identified (for example, BRCA1, BRCA2 or TP53). [2004]
Patient education and information
Information for women who are being referred1.3.7 Women who are being referred to secondary care or a specialist genetic clinic should be provided with written information about what happens at this stage. [2004]
Information and ongoing support for women who are not being referred1.3.8 Support mechanisms (for example, risk counselling, psychological counselling and risk management advice) need to be identified, and should be offered to women not eligible for referral and/or surveillance on the basis of age or risk level who have ongoing concerns. [2004]
Support for primary care1.3.9 Support is needed for primary care health professionals to care for women with a family history of breast cancer. Essential requirements for support for primary care are:
Reference: http://www.nice.org.uk/guidance/cg164/chapter/1-recommendations#care-of-people-in-primary-care
Care and management in primary care1.3.1 People without a personal history of breast cancer can be cared for in primary care if the family history shows only one first-degree or second-degree relative diagnosed with breast cancer at older than age 40 years[4], provided that none of the following are present in the family history:
- bilateral breast cancer
- male breast cancer
- ovarian cancer
- Jewish ancestry
- sarcoma in a relative younger than age 45 years
- glioma or childhood adrenal cortical carcinomas
- complicated patterns of multiple cancers at a young age
- paternal history of breast cancer (two or more relatives on the father's side of the family). [2004]
Referral from primary care1.3.3 People without a personal history of breast cancer who meet the following criteria should be offered referral to secondary care:
- one first-degree female relative diagnosed with breast cancer at younger than age 40 years or
- one first-degree male relative diagnosed with breast cancer at any age or
- one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years or
- two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age or
- one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative) or
- three first-degree or second-degree relatives diagnosed with breast cancer at any age. [2004]
- bilateral breast cancer
- male breast cancer
- ovarian cancer
- Jewish ancestry
- sarcoma in a relative younger than age 45 years
- glioma or childhood adrenal cortical carcinomas
- complicated patterns of multiple cancers at a young age
- paternal history of breast cancer (two or more relatives on the father's side of the family). [2004]
1.3.6 Direct referral to a specialist genetics service should take place where a high-risk predisposing gene mutation has been identified (for example, BRCA1, BRCA2 or TP53). [2004]
Patient education and information
Information for women who are being referred1.3.7 Women who are being referred to secondary care or a specialist genetic clinic should be provided with written information about what happens at this stage. [2004]
Information and ongoing support for women who are not being referred1.3.8 Support mechanisms (for example, risk counselling, psychological counselling and risk management advice) need to be identified, and should be offered to women not eligible for referral and/or surveillance on the basis of age or risk level who have ongoing concerns. [2004]
Support for primary care1.3.9 Support is needed for primary care health professionals to care for women with a family history of breast cancer. Essential requirements for support for primary care are:
- a single point and locally agreed mechanism of referral for women identified as being at increased risk
- educational materials about familial breast cancer
- decision-support systems
- standardised patient information leaflets
- a designated secondary care contact to discuss management of 'uncertain' cases. [2004]
Reference: http://www.nice.org.uk/guidance/cg164/chapter/1-recommendations#care-of-people-in-primary-care
