Table 1.

Familial Risk Stratification and Management (based on NICE guidelines)

Women’s history	Decision support assessment	Action
No family history	Average risk—“population risk” (Defined as lifetime risk of breast cancer less than 17%)	Remained under management of primary care and mailed reassuring familial risk informationb and a breast awareness leaflet
Family history of breast cancer but assessed at no increased risk based on national guidelinea	Average risk—“near population risk” (Defined as lifetime risk of breast cancer less than 17%)	Remained under management of primary care and mailed reassuring familial risk informationb and a breast awareness leaflet
Family history of breast/ovarian/prostate cancer assessed to be significant based on national guidelinea	Increased risk (Women with a significant family history: ≥ 17% lifetime risk of breast cancer)	Posted a letter from their GP informing them of their increased risk and offered specialist referral. Option to invite patient see physician to discuss prior to referral
Family history of breast/ovarian/prostate of uncertain significance based on national guidelinea	Uncertain Risk	GPs advised to discuss women’s family history information with a secondary care specialist to determine if they were at average or increased risk

^aNational Institute for Health and Care Excellence. Familial breast cancer: classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. Update of clinical guideline 14 and 41. (Clinical guideline 164.) 2013. https://guidance.nice.org.uk/CG164

^bInformation document explaining woman at average lifetime risk of breast cancer. Also included information adopated from charity Breakthrough Breast Cancer on what can increase or reduce breast cancer risk