Primary care management of women at risk of familial breast or ovarian cancer

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Primary care management of women at risk of
familial breast or ovarian cancer

• Dr. Judith Hayward
• GPwSI in Genetics

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Breast and Ovarian Cancer Guidance

• Based on Familial Breast Cancer (NICE, updated
  October 2006)
• The classification and care of women at risk of
  familial breast cancer in primary, secondary and
  tertiary care

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Familial Breast Cancer (NICE)
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PACE Guideline
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Role of Primary Care (NICE, 2006)

• A first and second degree family history should
  be taken to assess risk
• Women at or near population risk should be cared
  for in Primary Care

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Role of Primary Care (NICE, 2006)

• A first and second degree family history should
  be taken to assess risk
• Women being referred should receive information
  regarding
• Potential outcomes of the referral
• Why they are being referred to a genetics service
• What to expect, including counselling and testing
• The risk assessment that may take place, and that
  a comprehensive family history may be required
• This should all be included in the leaflet You
  have been referred to YRGS regarding your family
  history

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If family history unclear

• Can ask patient to find out more and then come
  back to discuss further
• Can ask for advice from GPwSI in Genetics
  (judith.hayward_at_bradford.nhs.uk)
• Can refer directly to Yorkshire Regional Genetics
  Service

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Role of Primary Care (NICE 2006)

• Women at or near population risk should be cared
  for in Primary Care
• They should receive standard information (see box
  in PACE Guidelines)
• Be Breast Aware (NHS Breast Screening Programme
  and Cancer Research UK)
• Are you worried about Breast Cancer? (Cancer
  Backup)

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Other resources for patients

• www.cancerbackup.org.uk
• 0808 800 1234
• www.cctrust.org.uk
• 020 7704 1137

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Risk Factors / Lifestyle Advice (NICE)

• HRT
• Hormonal Contraceptives
• Advice up to 35 yoa should be in keeping with
  general health advice regarding the OCP
• Advice over 35 yoa increased risk of breast
  cancer with taking the OCP given that their
  absolute risk increases with age
• (FFP The relative risk of breast cancer with OCP
  is 1.0 and is not affected by family history
  (2006))
• This does not apply to patients with BRCA
  mutations

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Risk Factors / Lifestyle Advice (NICE)

• Breastfeeding decreases risk
• Alcohol may increase risk slightly
• Smoking
• Physical activity
• Probable increased post-menopausal risk of breast
  cancer associated with being overweight
• Potential benefits of exercise on breast cancer
  risk