Intended for healthcare professionals


Family history of breast cancer

BMJ 2005; 330 doi: (Published 24 March 2005) Cite this as: BMJ 2005;330:730

Referral guidelines changed after acceptance of 10 minute consultation

  1. D Gareth Evans (gareth.evans{at}, consultant geneticist,
  2. Douglas Easton, genetic epidemiologist
  1. St Mary's Hospital, Manchester M13 0JH

EDITOR—In their 10 minute consultation on family history of breast cancer Lucassen and Watson drew attention to the recently published guidelines from the National Institute for Clinical Excellence (NICE) on familial breast cancer.1 2 It is unfortunate that the referral criteria were changed between the acceptance of this article in December 2003 and the final published guidelines in June 2004, which would result in the referral of the patient highlighted in the article for potential mammography screening, rather than for her reassurance.

Women aged 40-49 years at moderate risk of breast cancer are entitled to annual mammograms.2 The definition of moderate risk was based on a risk of at least 3% over the 10 year period from the age of 40 to 50. Available evidence, particularly from combined analyses of case-control studies of familial risks,3 indicates that a woman reaches this category with a first degree relative (mother or sister) with breast cancer when younger than 40 years or two relatives on the same side of the family (one first degree and one second degree or two first degree) diagnosed at any age.

The latter category differs from the draft NICE guidelines and previous referral criteria, which required that the two relatives be diagnosed at an average age of less than 60.4 This age restriction was removed because it could not be justified on the basis of the available data. It should be noted, however, that referral on the basis of two elderly close relatives is likely to be restricted to the age groups of 30-49, with referral of only high risk groups (for example, two affected relatives diagnosed at an average age of less than 50 years) outside this age group.


  • Competing interests DGE is chairman of the NICE Guideline Development Group on Familial Breast Cancer, and DE a guideline group member.


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