Care of Those at Near-population Risk

Safina has one female relative affected over the age of 40 with unilateral breast cancer. In the absence of any other family history, and if she has no Jewish Ashkenazi ancestry, she would fall into the near-population risk category.

However, she is clearly worried, particularly as her mother was ‘only 45’; we do know that people perceive their risk in the context of their own personal experience, culture and values.

How would you explain Safina’s risk assessment and reassure her?

It can be helpful to explain that breast cancer is common, up to 1 in 7 women will develop breast cancer at some point during their lifetime and that many women will have a relative who has developed breast cancer without them having an increased chance of developing it.

Information Provision for People Concerned About Familial Cancer Risk

NICE recommend the following:

Standard written information for all

• Risk information about population level and family history levels of risk, including a definition of family history
• If their family history alters, their risk may alter
• Breast awareness information
• Lifestyle advice regarding breast cancer risk Includes information about: HRT and oral contraceptives (women only); lifestyle, including diet, alcohol, etc; breastfeeding, family size and timing (women only).
• Contact details of those providing support and information, including local and national support groups.
• People should be informed prior to appointments that they can bring a family member/friend with them to appointments.
• Details of any trials or studies that may be appropriate.

For people cared for in primary care

• Advice to return to discuss any implications if there is a change in family history or breast symptoms develop.

NICE guidance summarises information provision for people at all levels of risk; we will explore some of these wider clinical management issues later in this week’s course. It is also important to explain any screening programmes available at population level (e.g. NHS Breast Screening Programme) and to encourage patients to respond to screening invitations.

These management principles run throughout the management of patients at all levels of risk, and are also common to family histories of other cancers, so these form an important cornerstone for our management of family history of any cancer within primary care.