Breast disease

Question 1

When should a patient with a family history of breast cancer be referred for specialist review and when it is not necessary?

Answer 1

Refer to secondary care women with:
* 1st degree relative with BC diagnosed before age 40
* 1st degree male relative with BC at any age
* 1st degree relative with bilateral breast cancer
* 2x 1st degree or 1x 1st degree & 1x 2nd degree relatives with breast cancer at any age
* 1x 1st/2nd degree relative with breast cancer at any age AND 1x 1st/2nd degree relative with ovarian cancer at any age (one of these should be a 1st degree relative)

A woman with only a history of breast cancer in ONE first or second degree relative where it was diagnosed OVER 40 doesn’t require referral UNLESS there is a family history of:
BILATERAL breast cancer
male breast cancer
there is Jewish ancestry (higher risk of BRCA carrier)
there is concurrent family history of ovarian cancer
there is a history of sarcoma in a relative < 45 years old
a family history of glioma
a family history of complicated multiple cancers at an early age
strong paternal history of breast cancer (2x or more relatives on the father’s side of the family)

If any of these factors are present then their case should be discussed with secondary care for advice & guidance.

Question 2

Which cancers does BRCA2 mutation in men increase the risk of ?

Answer 2

Breast cancer
Early-onset prostate cancer
Malignant melanoma
Pancreatic cancer