What is the breast cancer risk assessment service?
On average about on in eight women will develop breast cancer. A small number of women may have an increased risk of developing breast cancer because they have a significant family history of the disease or have other known risk factors. The breast cancer risk and assessment service is for people who may be concerned about their family history of breast and/ or ovarian cancer. Women who are concerned about a potential family history of breast cancer are advised to see their GP who will make a referral to the Family History Clinic if necessary. An appointment can be made to attend one of our clinics for a risk assessment and screening recommendations.
Please note that Family History Referrals are only for patients who are asymptomatic. Symptomatic patients should be referred to a symptomatic surgical breast clinic.
If you have any breast changes or have concerns about your health then please contact your GP.
1.3.3 People without a personal history of breast cancer who meet the following criteria should be offered referral to secondary care. You may be eligible for an appointment if you have:
- One first- degree female relative diagnosed with breast cancer at younger than 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] 1.3.4
What happens before the clinic?
On receipt of a referral, usually from your GP all new patients will be sent a family history questionnaire. This information is used as part of the risk assessment process. We ask that this be completed to the best of your ability, although we understand that it may not always be possible to know all the details. The questionnaire is used to draw the family tree. A series of calculations are made based on this information. The more information we have about your family, their ages, any cancers they have had diagnosed and the ages these were diagnosed enables us to more accurately estimate your risk. Once the completed questionnaire is returned we can make you an appointment to attend the clinic. In some cases it is not always necessary to attend the clinic and we will write to your GP if this is the case.
What happens at the clinic?
Clinics are held every week in the Family History Department situated in The Nightingale Centre at Wythenshawe Hospital.
You will be seen by a doctor or nurse who specialises in familial breast cancer. Your family tree will be checked and other risk factors will be discussed with you. You may wish to bring a family member or friend along to the consultation .If you wish, you can be told what your risk of breast cancer is and a plan of care will be arranged for you.
Many women can be reassured that they are in the ‘Population Risk’ group and have a similar risk to other women in the population of the same age and can therefore be screened every three years from 50-70 as part of the National Breast Screening Programme.
Some women may be told that they have an increased risk which falls into a ’Moderate’ or ‘High’ risk group and may be advised of additional screening e.g in the form of annual mammography.
The Plan of Care
You will be given written information on how to check and examine your breasts and various risk factors and lifestyle advice including diet, exercise, alcohol and HRT and contraceptive use. Following assessment your clinician may discuss chemoprevention [medication in tablet form that can help reduce the risk of developing breast cancer]. During the Family History Clinic women may be offered a clinical breast examination, and, if appropriate a mammogram. This will usually be performed on the same day as the consultation. The results of the mammogram take a few days to be reported, a letter informing patients of the results will then be sent to you. If further images are required, such as an ultrasound or a 3D mammogram image then you will be sent an appointment through the radiology service for this at a later date.
Some ladies may also be eligible to consider risk reducing surgery or benefit from a referral to the regional genetics centre at St. Mary’s. Details of any research trials or studies may also be discussed with you if appropriate.
In Summary
If you have been told that you have an increased risk of breast cancer and are eligible for early or additional screening this will be scheduled for you through a family history service, either here at the Nightingale Centre or at a centre nearer to your home on an annual basis. The risk that you have been given is based on the information that you have told us at the time. It is important that you inform us of any changes in your family history [such as a new cancer diagnosis] as this may change your risk and screening recommendations.
Please remember that if you have any breast concerns or symptoms in between any screening appointments with us you need to discuss these with your GP as you may need a referral to a surgical symptomatic clinic. The family history is only for routine assessment and screening.
Contact details:
If you have any queries regarding your care or treatment then please get in touch:
Family History Risk and Prevention Secretaries:
Office hours are Monday to Friday 9-4.30 pm:
0161 291 4422
Family History Nurses office:
Monday to Friday 8-4.30 pm:
0161 291 4420