Breast cancer family history risk assessment

1. What to do if you're concerned about your family history
2. Your family history risk assessment appointment
3. Different levels of breast cancer risk
4. Understanding your risk after a diagnosis of breast cancer
5. Talking to your family about your risk
6. Genetic counselling
7. Support if you’re an increased risk

1. What to do if you're concerned about your family history

If you’re concerned about your family history of breast cancer, you may be able to have a family history risk assessment. A family history risk assessment will try to find out if you are at general population, moderate or high risk of breast cancer. 

Listen to a discussion of family history FAQs with one of our nurses.


The first step is to talk to a healthcare professional. Who you should talk to first will depend on your situation.

  • If you have not had breast cancer yourself, you can talk to your GP (local doctor), who will ask about your family history and may refer you to a specialist family history clinic or a regional genetics centre (depending on where you live).

  • If you have been diagnosed with breast cancer yourself, you can speak to a member of your specialist breast care team who will be able to refer you to a specialist family history clinic or a regional genetics centre if appropriate.

You should be referred for further assessment of your risk if:

  • you or one close relative has had breast cancer before the age of 40

  • you or one close relative has had breast cancer in both breasts (bilateral breast cancer)

  • you have had breast cancer known as triple negative (in particular if you were diagnosed under the age of 50)

  • you and one close relative have had breast cancer

  • two or more close relatives have had breast cancer

  • you have close relatives who have had breast cancer and others who have had ovarian cancer

  • a male relative has had breast cancer

  • you are of Ashkenazi Jewish ancestry.

You might also be referred if:

  • you or a relative has had sarcoma (cancer in the connective tissues, for example in the muscle or bone) before the age of 45
  • you or a relative has had glioma (a type of brain tumour) or childhood adrenal cortical cancer (cancer in the outer layer of the adrenal gland)
  • your family has had a number of cancers at a young age
  • your family has had a number of cancers linked to one of the other rare inherited altered genes.

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2. Your family history risk assessment appointment

Try to find out as much about your family history as you can from other relatives before your appointment. You may be asked to complete a questionnaire about your family history before being offered an appointment or you may be asked for this information at your appointment. The person looking at your family history will understand if you can’t find all the relevant information.

At the appointment you’ll be asked about any type of cancer in all your blood relatives on both sides of your family. This includes your mother and father, sons and daughters, brothers and sisters, aunts and uncles, nieces and nephews, cousins, grandparents, great uncles and great aunts.

You’ll be asked:

  • for your known family history on both sides, including family members who have not had cancer, and the age at which any of them died
  • how the people diagnosed with cancer are related to you (for example mother, father, sister, brother, cousin)
  • how the people diagnosed with cancer are related to each other
  • what type of cancer each person had
  • how old each person was when diagnosed
  • whether the same person has had more than one cancer (including cancer in both breasts)
  • your ethnic background
  • about your own breast cancer diagnosis (if you have been diagnosed).

If you don’t have information about your family history or blood relatives, your risk assessment can only be based on whatever information you have.

At the end of your appointment, if your specialist team has enough information you will be told what your level of risk is based on your family history.

Healthcare professionals can’t say for sure whether someone will develop breast cancer and a person’s level of risk may change over their lifetime, for example if a close relative develops breast or ovarian cancer in the future.

Whatever your breast cancer risk is, you’ll be offered information and support that’s relevant to you as an individual.

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3. Different levels of breast cancer risk


Breast cancer risk is classed as either at general population level, moderate or high risk.

General population risk (average or near population risk)

If a person is at general population risk, this means their risk of developing breast cancer as a result of their family history is the same as (or very similar to) that of the general population.

If only one person in your family has been diagnosed with breast cancer over the age of 40, you’re likely to be at general population risk. Most breast cancers are not inherited and so do not increase the lifetime risk for other family members.

As breast cancer is the most common cancer in the UK, if you’re at general population risk it’s important to be breast aware and go to your GP if you notice any unusual changes.

Between the ages of 50 and 70, women are invited for routine breast screening every three years as part of a national breast screening programme

It’s important to go back to your GP if your family history changes – for example if another relative develops breast or ovarian cancer.

Moderate risk (familial or raised risk)

People in this category are at higher risk than the general population, but it’s still more likely that they won’t get breast cancer as a result of their family history.

A person at moderate risk may have several relatives with breast cancer but no obvious pattern of the disease. Although breast cancer might have affected people in several generations of their family, they tend to be affected at older ages. A person may also be considered at moderate risk if one close relative developed breast cancer under the age of 40.

If you’re at moderate risk, you’re likely to be offered regular screening. Your specialist may also discuss with you the possibility of risk-reducing drug treatment.  

It’s important to go back to your GP if your family history changes – for example if another relative develops breast or ovarian cancer.

High risk (hereditary or increased risk)

People in this category are more likely than those at moderate risk to develop breast cancer but this doesn’t mean they definitely will.

A person at high risk will usually have several close relatives (on either the mother or the father’s side) with breast cancer, ovarian cancer or both over several generations – for example grandmother, mother and daughter – who are often diagnosed at a young age.

If you’re at high risk, you will be given more information on the options available to you, including breast screening and risk-reducing treatments. You may be offered genetic counselling and the possibility of genetic testing will be discussed.

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4. Understanding your level of risk after a diagnosis of breast cancer

If you’ve been diagnosed with breast cancer, your specialist will discuss the risk of the cancer coming back (recurrence).

Having had breast cancer also slightly increases your risk of developing a new primary breast cancer and your family history may increase this risk further.

If your family history puts you at moderate or high risk, you will continue to have increased screening after your follow-up period ends to check for signs of a new primary breast cancer.

If you are at high risk, your specialist may discuss the possibility of additional surgery to reduce the risk of developing a new primary breast cancer. If you are found to be a gene carrier, your specialist may also discuss surgery to reduce the risk of ovarian cancer. Find out more about risk-reducing surgery.

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5. Talking to your family about your breast cancer risk

If you’re at an increased risk of breast cancer, this will mean that other members of your family will also be at an increased risk. It’s important to talk to your family so that they are aware of this. They then have the chance to make choices about having their own risk assessed and managing their risk.

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6. Genetic counselling

If you’re considered to be at high risk of developing breast cancer, have a complex family history or if further investigation into your family history would be helpful in understanding your risk, you will be offered a genetic counselling appointment at a regional genetics centre.

You’ll meet with a genetic counsellor (a healthcare professional with specialist knowledge about genetics and inherited illnesses) or a clinical geneticist (a doctor with specialist training in genetics).

They can help you understand more about your family history, your risk of developing breast cancer (and possibly other cancers) and the options that may be available to you, such as genetic testing, breast screening and treatments to reduce the risk of cancer developing. Sometimes this may be done over several visits.

For some people, genetic counselling can be a very emotional time. You may feel anxious talking about your risk and what this means for you and those around you. Your genetic counsellor will have a lot of experience talking through the issues involved and will be able to offer you support if you need it.

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7. Support if you're at increased risk of breast cancer

Concerns about you or other family members inheriting breast cancer are very common for women who have a family history of breast cancer.

Finding out that you and your family are at increased risk of developing breast cancer can cause many different emotions. You may feel more anxious about your breast health or afraid of what the future holds for you. 

Breast cancer not only affects you but also your relationships with other members of your family. If you have children you may find that you have concerns about their health – or new anxieties about having children.

All cancer genetics clinics have genetic counsellors who you can talk to about how you’re feeling.

You can call our free Helpline on 0808 800 6000 or use our Ask Our Nurses email service if you are concerned about breast cancer in families.

Our Someone Like Me service can put you in touch with a trained volunteer who has had experience of the issues you’re facing.

You can also find support day or night from people who have experienced what you’re going through on the Genes and breast cancer section of our Forum. 

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Last reviewed: March 2017
Next planned review begins 2019

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Please note that we cannot respond to comments. If you have any questions about breast cancer please contact the Helpline on 0808 800 6000.

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