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    Breast cancer – managing FH – Summary.

    A family history of breast cancer is one of the strongest risk factors for breast cancer and the probability that a woman will develop breast cancer increases depending on the number of affected relatives.

    Risks associated with family history are modified by other breast cancer risk factors, including age of menopause, parity, and breastfeeding.

    If there are concerns about a woman’s family history, it should be determined whether a faulty gene has been identified in the family and whether a family member has had cancer and when.

    If a faulty gene has been identified in the family, direct referral to a specialist genetics service should be offered.

    If there is no first- or second-degree maternal or paternal family history of breast cancer, the woman can be managed in primary care and offered appropriate information and reassurance.
    If there is a first- or second-degree family history, but of only one relative who developed breast cancer after 40 years of age, the woman can be managed in primary care.
    If there is a first- or second-degree family history of breast cancer affecting a relative 40 years of age or younger, or more than one relative, the need for referral depends on the woman’s age and level of risk.
    If it is impossible to assess risk accurately, but a woman is particularly concerned about her risk of breast cancer, referral or discussion with secondary or tertiary care may be necessary.

    A discussion on risk reduction should include advice on:
    Breast awareness for all women.
    Attendance at the local breast-screening programme for women 50 years of age and older.
    Known (potentially modifiable) risk factors for breast cancer.

    Advice should be offered on hormonal contraception:
    The UK Medical Eligibility Criteria (UKMEC) state that a family history of breast cancer is not a contraindication to any form of hormonal contraception or intrauterine device.

    If the woman is a carrier of a known gene mutation associated with breast cancer (e.g. BRCA1), combined hormonal contraceptives should generally not be used as the proven risks outweigh the benefits.

    If a woman is considering hormone replacement therapy (HRT), specialist advice should be sought if she fulfils the criteria for specialist assessment of her risk of breast cancer.

    For other women considering, or already taking, HRT:
    Information should be given on the increase in breast cancer risk (associated with the type and duration of treatment).
    Dose and duration of treatment should be kept as low as possible.
    If a woman is at moderate-to-high risk of breast cancer, HRT should only be given until she reaches 50 years of age.

    Dr G Mohan.

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