Excerpt

The scope of this guideline was care, and classification, of women at risk of breast cancer because of family history. The guideline covers women aged 18 years and older. It does not cover women who have breast cancer. It does not cover the care and management of men who may be at risk because of family history. The guideline addresses care in primary, secondary and tertiary care in respect of these women. However, the guideline does not cover in detail some aspects of some interventions that may be relevant, for example it does not address methods of screening in detail as that is outwith the scope.

Contents

• October 2006 Update
• 1. Key priorities for implementation
  • Approaches to care
  • Family history and referral
  • Care
• 2. Guideline development
  • 2.1 The guideline
  • 2.2 Using guidelines
  • 2.3 Responsibility and support for the guideline
  • 2.4 Scope of the guideline
  • 2.5 Key clinical questions
  • 2.6 Evidence identification
  • 2.7 Evidence grading
  • 2.8 Derivation and grading of recommendations
  • 2.9 Cost effectiveness review and analysis
  • 2.10 Consensus in recommendations
  • 2.11 Guideline review
• 3. Women with a family history of breast cancer
  • 3.1 Introduction
  • 3.2 Incidence and prevalence
  • 3.3 The role of family history
  • 3.4 Impact on individuals with a family history of breast cancer
• 4. Risk assessment and classification (including family history taking) and risk communication
  • 4.1 Risk estimation
  • 4.2 Risk classification
  • 4.3 Family history taking
  • 4.4 Risk assessment tools
  • 4.5 Risk communication
• 5. Approaches to care and information giving
  • 5.1 Approaches to care and information giving
  • 5.2 Breast awareness and examination
• 6. Care of women in primary care
  • 6.1 Care and management approach – primary care
  • 6.2 Patient education/information in primary care
• 7. Care of women in specialist (secondary and tertiary) care
  • 7.1 Specialist care - care and management approach
  • 7.2 Surveillance (secondary care)
  • 7.3 Genetic counselling (tertiary care)
  • 7.4 Genetic testing (tertiary care)
  • 7.5 Risk reducing mastectomy (tertiary care)
  • 7.6 Risk reducing oophorectomy
  • 7.7 Tamoxifen (tertiary care)
• 8. Risk factors
  • 8.1 Risk factors
  • 8.2 Risk associated with family history
  • 8.3 Note re research literature
  • 8.4 Note re modifiable risk factors
  • 8.5 Hormone replacement therapy
  • 8.6 Hormonal contraceptives
  • 8.7 Breastfeeding
  • 8.8 Other reproductive/fertility issues
  • 8.9 Alcohol consumption
  • 8.10 Smoking
  • 8.11 Weight and physical activity
  • 8.12 Menstrual/reproductive factors
• 9. Audit criteria
  • Calculation of compliance
• 10. Research issues
• 11. Selected glossary
• 12. References
• 13. Appendices
  • Appendix 1 Family history taking
  • Appendix 2 Risk communication
  • Appendix 3 Patient education/information
  • Appendix 4 Genetic counselling
  • Appendix 5 Surveillance
  • Appendix 6 Genetic testing techniques
  • Appendix 7 Genetic testing, attitudes
  • Appendix 8 Genetic testing, psychosocial aspects
  • Appendix 9 Risk reducing mastectomy
  • Appendix 10 Risk reducing oophorectomy
  • Appendix 11 Tamoxifen
  • Appendix 12 Menstrual/reproductive factors
  • Appendix 13 Hormone replacement therapy
  • Appendix 14 Hormonal contraceptives
  • Appendix 15 Breastfeeding
  • Appendix 16 Other reproductive/fertility issues
  • Appendix 17 Alcohol consumption
  • Appendix 18 Smoking
  • Appendix 19 Obesity
  • Appendix 20 Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2
  • Appendix 21 Guideline development group
  • Appendix 22 Scope
  • Appendix 23 Related NICE guidance
  • Appendix 24 Literature searches
  • Appendix 25 Risk estimates table
  • Appendix 26 Breast cancer risk categorisation

Suggested citation:

McIntosh A, Shaw C, Evans G, Turnbull N, Bahar N, Barclay M, Easton D, Emery J, Gray J, Halpin J, Hopwood P, McKay J, Sheppard C, Sibbering M, Watson W, Wailoo A, Hutchinson A (2004) Clinical Guidelines and Evidence Review for The Classification and Care of Women at Risk of Familial Breast Cancer, London: National Collaborating Centre for Primary Care/University of Sheffield

This work is undertaken by ScHARR, University of Sheffield which received funding from the Royal College of General Practitioners on behalf of the National Institute for Clinical Excellence. The views expressed in this Publication are those of the authors and not necessarily those of either the Royal College of General Practitioners or the National Institute for Clinical Excellence.