Family history assessment

Assessing your risk of familial breast cancer

If you're concerned about your risk the first step is to talk things over with a healthcare professional.

If your family history suggests that you are at moderate or high risk or if another family member has already had their risk assessed, you're likely to be referred directly to a specialist breast or genetics clinic. Here you'll have further assessments of your family history and be given specialist advice, including looking at the different ways of helping you manage your risk.

Before your appointment try to find out as much as you can about your family history from other relatives.

You will be asked about:

• what type of cancer(s) have been diagnosed in your family
• how old each person was when they were diagnosed
• where in the body the cancer started
• whether the same family member has had more than one incidence of cancer
• your ethnic background
• whether the relatives with cancer are male or female.

An increased risk

A small number of women may be viewed as having a greater risk of developing breast cancer on the grounds of a strong family history.

If this applies to you, you will be classified as having a moderate risk or a high risk of developing breast cancer in the future. You're likely to be offered regular mammograms (breast x-rays) between the ages of 40 to 49. From the ages of 50 to 70 you'll be invited to attend for routine breast screening every three years. After the age of 70 you can refer yourself every three years by contacting your GP or screening centre directly.

Women at a high risk due to a faulty gene may be offered mammograms earlier than 40 and or Magnetic Resonance Imaging (MRI) screening, which has been shown to increase the number of breast cancers correctly diagnosed in younger women.

Genetic counselling

If you're referred for genetic counselling at your appointment you'll see a genetic counsellor, who is a health professional with specialist knowledge of genes and hereditary illnesses, or a geneticist, who is a doctor with specialist training in genetics.

They can help you understand more about your family history, your risk of developing breast cancer and the options that may be available to you, such as genetic testing, screening and surgery to reduce the risk of cancer.

Genetic testing

Genetic testing through the NHS is only available through a genetics department and following genetic counselling. Only a few people will be offered genetic testing and, even if it is an option for you, you may choose not to be tested.

First stage

Blood will be taken from a family member who has been diagnosed with breast or ovarian cancer to check for a known faulty gene. If you have had breast cancer then blood may be taken from you. Results can take several months. If no one who has had a breast cancer diagnosis is still alive your genetic counsellor will be able to advise you on the options available.

Faulty genes can be difficult to find, leading to an inconclusive genetic test. If there is no faulty gene in your family you have the same risk of developing breast cancer as other women in the general population.

Second stage

If a faulty gene is found a genetic test is available for other relatives to see whether or not they also carry the faulty gene.

It's important to remember that if you're found to carry a faulty breast cancer gene this does not necessarily mean you will go on to develop breast cancer. However, you have a higher risk than people without a faulty gene.

Other cancers

Carrying a faulty BRCA1 or BRCA2 gene gives you an increased risk of developing ovarian cancer.

There may also be a slightly increased risk of developing other cancers if you have a faulty BRCA gene.

Men who carry a faulty BRCA1 or BRCA2 gene may be at an increased risk of developing prostate cancer.

The TP53 gene is associated with rarer, more specific types of cancer - for example those that develop during childhood.

Insurance

Insurance companies will ask about your family's medical history and if you have a significant family history of breast cancer you may be charged a higher premium. However, if you've had a genetic test for breast cancer you don't have to disclose the result when applying for insurance.

Clinical trials

If you have genetic counselling it is possible you'll be asked to take part in one of the several clinical trials about breast cancer and family history.

For more information on clinical trials in general download our Clinical trials and breast cancer factsheet.

In the future

It’s important to go back to your GP if your family history changes – for example if another relative develops breast or ovarian cancer. If necessary you may then be referred to a breast or genetics clinic for further assessment and observation.

Information

The Royal Marsden specialist cancer centre in London has produced an information pack, A Beginner's Guide to BRCA 1 and BRCA 2, for people who've been told they are BRCA gene carriers.