Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)
Nightingale Breast Screening Centre & Prevent Breast Cancer Unit Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
Manchester Breast Centre, The Christie Hospital, Manchester M23 9LT, UK
Division of Cancer Sciences, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
Department of Surgery, King Edward VII’s Hospital, London W1G6AA, UK
Clinical Trials and Statistics Unit, The Institute of Cancer Research, London SM25PT, UK
Department of Psychology, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester M23 9LT, UK
Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester M23 9LT, UK
Division of Psychology and Mental Health, School of Health Sciences, Manchester Centre of Health Psychology, University of Manchester, Manchester M23 9LT, UK
NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
Faculty of Biology, Division of Evolution and Genomic Sciences, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
Authors to whom correspondence should be addressed.
Cancers 2020, 12(12), 3697; https://doi.org/10.3390/cancers12123697
Received: 22 November 2020 / Revised: 2 December 2020 / Accepted: 5 December 2020 / Published: 9 December 2020
(This article belongs to the Special Issue Gynaecological Cancers Risk: Breast Cancer, Ovarian Cancer and Endometrial Cancer)
This study reports the management of women at high risk for breast cancer over a 33 years period. The aim was to summarize the numbers seen and to report the results of our studies on gene testing, the outcomes of screening and the success of preventive methods including lifestyle change, chemoprevention and risk-reducing mastectomy. We also discuss how the clinical Family History Service may be improved in the future.
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.