NICE guidelines on surveillance of women with familial breast cancer risk

  • NICE

  • Oncology guidelines update
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NICE has concluded a review of its guidance on the management of familial breast cancer and has determined that no update is required.

Therefore, the current recommendations for surveillance of patients based on risk and age are as follows:

Moderate risk of breast cancer 1

  • 20-29 yrs: Do not offer mammography or MRI.
  • 30-39 yrs: Do not offer mammography or MRI.
  • 40-49 yrs: Annual mammography. Do not offer MRI.
  • 50-59 yrs: Consider annual mammography. Do not offer MRI.
  • 60-69 yrs: Mammography as part of the population screening programme. Do not offer MRI.
  • 70+ yrs: Mammography as part of the population screening programme.

High risk of breast cancer (but ≤30% probability of carrying BRCA or TP53) 2

  • 20-29 yrs: Do not offer mammography or MRI.
  • 30-39 yrs: Consider annual mammography. Do not offer MRI.
  • 40-49 yrs: Annual mammography. Do not offer MRI.
  • 50-59 yrs: Annual mammography. Do not offer MRI.
  • 60-69 yrs: Mammography as part of population screening. Do not offer MRI.
  • 70+ yrs: Mammography as part of population screening.

Untested but >30% BCRA carrier probability 3

  • 20-29 yrs: Do not offer mammography or MRI.
  • 30-39 yrs: Annual MRI and consider annual mammography.
  • 40-49 yrs: Annual mammography and annual MRI.
  • 50-59 yrs: Annual mammography. Do not offer MRU unless dense breast pattern.
  • 60-69 yrs: Mammography as part of population screening. Do not offer MRU unless dense breast pattern.
  • 70+ yrs: Mammography as part of population screening.

Known BRCA1 or BRCA2 mutation

  • 20-29 yrs: Do not offer mammography or MRI.
  • 30-39 yrs: Annual MRI and consider annual mammography.
  • 40-49 yrs: Annual mammography and annual MRI.
  • 50-59 yrs: Annual mammography. Do not offer MRI unless dense breast pattern.
  • 60-69 yrs: Annual mammography. Do not offer MRI unless dense breast pattern.
  • 70+ yrs: Mammography as part of population screening.

Untested but >30% TP53 carrier probability4

  • 20-29 yrs: Do not offer mammography. Annual MRI.
  • 30-39 yrs: Do not offer mammography. Annual MRI.
  • 40-49 yrs: Do not offer mammography. Annual MRI.
  • 50-59 yrs: Mammography as part of population screening. Do not offer MRI unless dense breast pattern.
  • 60-69 yrs: Mammography as part of population screening. Do not offer MRI unless dense breast pattern.
  • 70+ yrs: Mammography as part of population screening.

Known TP53 mutation

  • 20-29 yrs: Do not offer mammography. Annual MRI.
  • 30-39 yrs: Do not offer mammography. Annual MRI.
  • 40-49 yrs: Do not offer mammography. Annual MRI.
  • 50-59 yrs: Do not offer mammography. Consider annual MRI.
  • 60-69 yrs: Do not offer mammography. Consider annual MRI.
  • 70+ yrs: Do not offer mammography.

 

1Lifetime risk ≥17% but

2Lifetime risk ≥30% eg, Peutz-Jegher syndrome, Cowden syndrome, familial diffuse gastric cancer.

3Women with ≥30% BRCA carrier probability who reach 60 years without developing breast or ovarian cancer will have

4Women with ≥30% TP53 carrier probability who reach 50 years without developing breast cancer or any other TP53-related malignancy have