NICE clinical guidelines
Issued: June 2013
CG164

Familial breast cancer: Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg164

Introduction

This guideline updates and replaces the previous NICE guidance on familial breast cancer: NICE clinical guideline 14 (published May 2004) and NICE clinical guideline 41 (published July 2006). The recommendations are labelled according to when they were originally published (see About this guideline for details).

Familial breast cancer typically occurs in people with an unusually high number of family members affected by breast, ovarian or a related cancer. If more cases of breast, ovarian or a related cancer are seen in a family than would be expected by chance alone, this can be a sign that genes have caused or contributed to its development. Breast cancer in people who have a family history of breast, ovarian or a related cancer may need different management from that in people without a family history of these cancers. This is because of differences in the future risk of developing contralateral breast cancer.

The risk of developing breast cancer depends on the:

  • nature of the family history

  • number of relatives who have developed breast, ovarian or a related cancer

  • age at which relatives developed breast cancer

  • age of the person.

This guideline describes the classification and care of people at risk of familial breast cancer. It updates and replaces recommendations in NICE clinical guideline 41 on genetic testing thresholds, surveillance and risk reduction and treatment strategies for people without breast cancer who are at increased risk because of a family history of breast, ovarian or a related cancer.

This guideline also covers people with a diagnosis of breast cancer and a family history of breast, ovarian or a related cancer. It makes new recommendations on genetic testing thresholds, surveillance and risk reduction and treatment strategies. These areas are not covered by Early and locally advanced breast cancer (NICE clinical guideline 80) and are new areas for NICE guidance on familial breast cancer.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information. Where recommendations have been made for the use of drugs outside their licensed indications ('off-label use'), these drugs are marked with a footnote in the recommendations.