Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987-2020)

• Published in: Cancers Vol. 12; no. 12; p. 3697
• Main Authors: Howell, Anthony, Gandhi, Ashu, Howell, Sacha, Wilson, Mary, Maxwell, Anthony, Astley, Susan, Harvie, Michelle, Pegington, Mary, Barr, Lester, Baildam, Andrew, Harkness, Elaine, Hopwood, Penelope, Wisely, Julie, Wilding, Andrea, Greenhalgh, Rosemary, Affen, Jenny, Maurice, Andrew, Cole, Sally, Wiseman, Julia, Lalloo, Fiona, French, David P, Evans, D Gareth
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 09.12.2020; MDPI
• Subjects: Age; Anastrozole; BRCA1 protein; BRCA2 protein; Breast cancer; Counseling; Estrogen receptors; Family medical history; Gene families; Genes; Genetic screening; Genetics; Lifestyles; Mammography; Medical referrals; Mutation; Population; Primary care; Quality of life; Questionnaires; Raloxifene; Risk assessment; Surgeons; Surgery; Tamoxifen; Womens health; United Kingdom > UK; England; breast cancer; screening; risk; genes; family history; prevention
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers12123697

Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987-2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17-29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in and but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14-27% entered various lifestyle studies. From 1992-2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013-2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.