Patients with a family history of breast and/or ovarian cancer
NHS Tayside RefGuide
Who to refer?
Patients who are likely to be at an increased risk may have:
- 1 first degree relative with breast cancer diagnosed under the age of 40.
- Or 1 first degree relative with breast and ovarian cancer.
- Or 1 first degree male relative diagnosed at any age.
- Or 2 first or 1 first and 1 second degree relative with breast cancer diagnosed under 60 (or ovarian cancer at any age on the same side of the family).
- Or 3 or more first or second degree relatives with breast or ovarian cancer on the same side of the family, where one is a first degree relative of the consultand or of the consultand’s father.
Note: a case of bilateral breast cancer should be treated as the equivalent of 2 affected cases.
Note: breast cancer can be inherited through the paternal side.
Note: a first degree female relative is mother, sister or daughter. A second degree female relative is grandmother, granddaughter, aunt or niece who are first degree relatives of each other and at least one is a first degree relative of the consultand.
If you are unsure if your patient meets these criteria, please contact us to discuss.
The full guideline used for estimating risk and organising management of Familial Breast Cancer can be found in the breast cancer section of Scottish Cancer Clinical Management Pathways.
Why refer?
The purpose of a referral is to assess the risk to the patient on the basis of their family history supplemented by molecular genetic investigations in the small proportion of families at highest risk. We can arrange additional screening for women found to be at increased risk and risk-reducing surgery where appropriate.
Where to refer to?
There are clinics in Perth, Dundee and Arbroath, and these are usually run by Genetic Counsellors. The Genetics department is based at Ninewells Hospital.
Hereditary vs non-hereditary cancer
Most cancers occur by chance, but some have a predominantly hereditary origin. Inherited mutations are only found in about 5% of women with breast cancer. The most well known genes are BRCA1 and BRCA2. For women with a BRCA1 mutation, by age 80, about 72% will develop breast cancer and 44% will develop ovarian cancer. For women with a BRCA2 mutation, by age 80, about 69% will develop breast cancer and 17% will develop ovarian cancer.
Breast cancers caused by the interaction of many genes and environmental factors, each having a small effect on cancer risk, may also cluster in families. Relatives of some women with cancer with a multifactorial aetiology may also have a significantly increased risk of cancer and may benefit from additional screening investigations but their risk will be substantially lower than the risk for women with an autosomal dominant predisposition.
Clues that a cancer may be hereditary include:
- More than one family member affected
- Cancers from a ‘group’ caused by mutations in the same gene (e.g. breast and ovarian cancer)
- A number of generations affected
- More likely to be diagnosed at younger ages (<40).
Contact
- Clinical Genetics, Level 6, Ninewells Hospital, Dundee.
- Email: Tay.clinicalgenetics@nhs.scot
- Tel: 01382 632035