This guidance updates and replaces NICE clinical guideline 14 (published May 2004) and NICE clinical guideline 41 (published July 2006).

New and updated recommendations have been included 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. New recommendations have been included on genetic testing thresholds, subsequent surveillance and risk-reduction and treatment strategies for people with a diagnosis of breast cancer and a family history of breast, ovarian or a related cancer.

Contents

• Foreword
• Key priorities
• Key research recommendations
• List of all recommendations
• Methodology
• Algorithms
• 1. Epidemiology
  • 1.1. Introduction
  • 1.2. Methodology
  • 1.3. Disease Burden
  • 1.4. Current practice on management of families with familial breast cancer
  • 1.5. Comments on genetic service provision
  • 1.6. Summary
  • References (2013)
• 2. The clinical significance of a family history of breast cancer
  • 2.1. Clinical classification
  • 2.2. Breast cancer risk and a family history of breast cancer
  • 2.3. Family history-taking
  • 2.4. Accuracy of family history
  • 2.5. Family history and carrier probability
  • 2.6. Communicating cancer risk and carrier probability
  • References (2004)
  • References (2013)
• 3. Information and support
  • Clinical evidence (2004)
• 4. Care of people in primary care
  • 4.1. Care and management in primary care
  • 4.2. Patient education and information
  • References (2004)
• 5. Care of people in secondary care and specialist genetic clinics
  • 5.1. Care and management
  • 5.2. Genetic counselling for people with no personal history of breast cancer
  • References (2004)
• 6. Genetic testing
  • 6.1. Genes associated with inherited breast cancer risk
  • 6.2. Genetic testing for people with a family history but no personal history of breast cancer (2004)
  • 6.3. Carrier probability at which genetic testing should be offered
  • 6.4. Genetic testing for BRCA1, BRCA2 and TP53 within 4 weeks of diagnosis of breast cancer
  • 6.5. Discussing the outcomes of genetic testing in people with a personal history of breast cancer
  • References (2004)
  • References (2013)
• 7. Surveillance and strategies for early detection of breast cancer
  • 7.1. Breast awareness
  • 7.2. Surveillance for women with no personal history of breast cancer
  • 7.3. Surveillance for women with a personal and family history of breast cancer
  • 7.3.1. Women with breast cancer and a family history
  • References (2013)
• 8. Risk reduction and treatment strategies
  • 8.1. Risk Factors
  • 8.2. Chemoprevention for women with no personal history of breast cancer
  • 8.3. Risk-reducing surgery
  • 8.4. Treatment options for people with a personal history of breast cancer who are TP53 mutation carriers
  • References (2004)
  • References (2013)
• Appendix A. Abbreviations
• Appendix B. Glossary
• Appendix C. Guideline scope
• Appendix D. People and organisations involved in the production of the guideline
• Appendix E. Removed sections from CG14 (2004) guideline
• Appendix F. Removed sections from CG41 (2006) guideline
• Appendix G. Updated recommendations from CG14/CG41 (2004 & 2006)
• An assessment of need
• Evidence Review

Recommendations are marked to indicate the year of the last evidence review:

• [2004] if the evidence has not been reviewed since the original guideline.
• [2004, amended 2013] indicates that the evidence has not been updated and reviewed since 2004 but an amendment has been made to the recommendation.
• [2006, amended 2013] indicates that the evidence has not been updated and reviewed since 2006 but an amendment has been made to the recommendation.
• [2013] indicates that the evidence has been reviewed but no changes have been made to the recommendation.
• [new 2013] if the evidence has been reviewed and the recommendation has been updated or added.

Appendix G contains recommendations from the [2004 & 2006] guideline that have been deleted from this [2013] update. Details of any replacement recommendations are also included.