TY - JOUR
T1 - Long-term evaluation of women referred to a breast cancer family history clinic (Manchester UK 1987–2020)
AU - Howell, Anthony
AU - Gandhi, Ashu
AU - Howell, Sacha
AU - Wilson, Mary
AU - Maxwell, Anthony
AU - Astley, Susan
AU - Harvie, Michelle
AU - Pegington, Mary
AU - Barr, Lester
AU - Baildam, Andrew
AU - Harkness, Elaine
AU - Hopwood, Penelope
AU - Wisely, Julie
AU - Wilding, Andrea
AU - Greenhalgh, Rosemary
AU - Affen, Jenny
AU - Maurice, Andrew
AU - Cole, Sally
AU - Wiseman, Julia
AU - Lalloo, Fiona
AU - French, David P.
AU - Evans, D. Gareth
N1 - Funding Information:
Acknowledgments: D.G.E., E.F.H., S.J.H., D.P.F. and A.H. are supported by the National Institute for Health Research (NIHR) BRC Manchester (Grant Reference Number: 1215-200074). This work was also supported by Prevent Breast Cancer and Breast Cancer Now. We thank all the women referred to the clinic, the many unnamed individuals who have helped run the clinic over the years and the many investigators who have assisted with our clinical studies.We also thank Lorna McWilliam for comments on the manuscript.
Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2020/12/9
Y1 - 2020/12/9
N2 - Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
AB - Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
KW - Breast cancer
KW - Family history
KW - Genes
KW - Prevention
KW - Risk
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=85098504169&partnerID=8YFLogxK
U2 - 10.3390/cancers12123697
DO - 10.3390/cancers12123697
M3 - Article
AN - SCOPUS:85098504169
SN - 2072-6694
VL - 12
SP - 1
EP - 19
JO - Cancers
JF - Cancers
IS - 12
M1 - 3697
ER -