GP writes first prescription	Secondary care clinician writes first prescription
Moderate:17–30% lifetime risk	Sarah is a 45-year-old woman with a family history of breast cancer. She consulted you previously and was referred to a local family history clinic for risk assessment. A family history clinician assessed her as having a moderate risk of breast cancer. This means she has a lifetime risk of between 17% and 30%. Sarah has discussed the potential harms and benefits of taking tamoxifen for 5 years with the family history clinician. She has expressed an interest in taking tamoxifen. Sarah is premenopausal with no menstrual dysfunction, is not planning pregnancy, has no contraindications, and is taking no other medications. The family history clinician supports her decision to take tamoxifen and has also referred her for additional screening. The family history clinician requested that you write the first prescription and continue to act as the main prescriber.	Sarah is a 45-year-old woman with a family history of breast cancer. She consulted you previously and was referred to a local family history clinic for risk assessment. A family history clinician assessed her as having a moderate risk of breast cancer. This means she has a lifetime risk of between 17% and 30%. Sarah has discussed the potential harms and benefits of taking tamoxifen for 5 years with the family history clinician. She has expressed an interest in taking tamoxifen. Sarah is premenopausal with no menstrual dysfunction, is not planning pregnancy, has no contraindications, and is taking no other medications. The family history clinician supports her decision to take tamoxifen and has also referred her for additional screening. The family history clinician has written the first prescription, and has requested that you take over as the main prescriber.
High: 30% lifetime risk	Sarah is a 45-year-old woman with a family history of breast cancer. She consulted you previously and was referred to a local family history clinic for risk assessment. A family history clinician assessed her as having a high risk of breast cancer. This means she has a lifetime risk of ≥30%. Sarah has discussed the potential harms and benefits of taking tamoxifen for 5 years with the family history clinician. She has expressed an interest in taking tamoxifen. Sarah is premenopausal with no menstrual dysfunction, is not planning pregnancy, has no contraindications, and is taking no other medications. The family history clinician supports her decision to take tamoxifen and has also referred her for additional screening. The family history clinician requested that you write the first prescription and continue to act as the main prescriber.	Sarah is a 45-year-old woman with a family history of breast cancer. She consulted you previously and was referred to a local family history clinic for risk assessment. A family history clinician assessed her as having a high risk of breast cancer. This means she has a lifetime risk of ≥30%. Sarah has discussed the potential harms and benefits of taking tamoxifen for 5 years with the family history clinician. She has expressed an interest in taking tamoxifen. Sarah is premenopausal with no menstrual dysfunction, is not planning pregnancy, has no contraindications, and is taking no other medications. The family history clinician supports her decision to take tamoxifen and has also referred her for additional screening. The family history clinician has written the first prescription, and has requested that you take over as the main prescriber.