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FAMILIAL BREAST CANCER QUESTIONNAIRE

Mr. George Alex MBBS, MRCS Ed

Contact details:
Breast Unit
Castle Hill Hospital
Castle Road, Cottingham HU16 5JQ
East Yorkshire, United Kingdom

ABSTRACT

Breast cancer is the most common cancer in the UK. There are several risk factors for developing breast cancer, one of which is a family history of breast or ovarian cancer. However the great majority of women with family history of breast cancer do not fall into a high risk category and are not at substantially increased risk of breast cancer themselves.
If a woman has concerns about her family history, she would normally make a general practitioner appointment for risk assessment and/or appropriate referral. Inappropriate clinic appointments and referrals cost both the patient and the health care system in time, money and effort.

A questionnaire has been formulated based on the National Institute for Health and Clinical Excellence (NICE) guidelines. It seeks to identify all women that have more than 3% 10-year risk of developing breast cancer in view of their family history. Its objective is to help women with a family history of breast or ovarian cancer to find out for themselves prior to making a general practitioner appointment whether they could be at increased risk of developing breast cancer. The questionnaire could be made available as a leaflet to any health related service like the GP Surgery, Community clinics or Well woman clinics. After going through the questionnaire an informed decision could be made whether or not to see their general practitioner for risk assessment and/or appropriate referral.

The NICE Guideline suggests women at or near population risk of developing breast cancer as those having a 10-year risk of less than 3% for women aged 40-49 years and a lifetime risk of less than 17%. These women are cared for in primary care (E.g. GP Surgery).

Raised and High risk women are those with a 10 year risk of 3-8% (17 - 29% lifetime risk) or more than 8% 10 year risk (> 29 % lifetime risk) respectively. Women at raised or high risk are cared for Secondary (E.g. Hospital Family History Clinics) or Tertiary care (E.g. Genetics Centres).

Key Words: Breast Cancer, Familial Cancer, Ovarian Cancer, National Institute for Health and Clinical Excellence, risk assessment

Breast or Ovarian Cancer in the family?

Have you ever worried whether there is a higher chance of your developing breast cancer because there is someone in your family with a cancer? Answering the questions below can help give you a clearer idea as to whether you may be at risk.

Questionnaire

1. Has your mother, father, sister, brother, daughter or son had breast cancer before the age of 40?

2. Has your father, brother or son had breast cancer?

3. Have any 2 of the following had breast cancer: your mother, father, sister, brother, daughter or son?

4. Has your mother, father, sister, brother, daughter or son had breast cancer?
If yes, has a grandmother, grandfather, granddaughter, grandson, aunt, uncle, niece, nephew, half sister or half brother had breast cancer?
If so, is their average age (adding their ages and dividing it by 2) less than 50?

5. Have any 3 of the following had breast cancer: your mother, father, sister, brother, daughter, son, grandmother, grandfather, granddaughter, grandson, aunt, uncle, half sister or half brother?

6. Has your mother, father, sister, brother, son or daughter had cancer in both breasts?
If so, did they have cancer on one breast before the age of 50?

7. Has your mother, sister, daughter, grandmother, granddaughter, aunt or a half sister had o ovarian cancer?
If so, has your mother, father, a sister, a brother, a daughter, a son, grandmother, an aunt, or a half sister had breast cancer?
If so, has your father, a brother or a son had breast cancer or have your mother, a sister or a daughter had breast or ovarian cancer?

8. Are you known to have a faulty breast cancer gene?

9. Are your parents, grandparents or ancestors Jewish?

10. Are there any unusual cancers in the family i.e. Sarcoma (cancer of bone, cartilage, fat, muscle, blood vessels) before the age of 45, gliomas (cancer that starts in the brain or spine) or different types of cancers at a young age?

11. Have any 4 of your family members had breast cancer?
If yes, has your mother, father, sister, brother, son or a daughter had breast cancer?

12. Have any 2 of the following had breast cancer before the age of 60– your father, grandfather, brother, half brother or a son?

13.Has any of your family members had ovarian cancer?
If so, has your mother, your father, sister, brother, daughter, son, grandmother, grandfather, granddaughter, grandson, aunt, uncle, half sister or a half brother had breast cancer before the age of 50?

14. Has any 2 of your family members had ovarian cancer?

15. Has any 2 of the following had breast cancer under the age of 60 – your mother, father, sister, brother, daughter, son, grandmother, grandfather, granddaughter, grandson, aunt, uncle, half sister or a half brother?

16. Is there any man in your family with breast cancer?
If so, in addition to that has your father, brother, son, grandfather, grandson, uncle or a half brother had breast cancer before the age of 50?

17. Have any 2 of the following had breast cancer before the age of 60 - your father, brother, son, grandfather, grandson, uncle or a half brother?

18.Have 2 of your family members had breast cancer with an average age (ages divided by 2) less than 30?
If so were either of them your mother or sister?

19.Have 3 of your family members had breast cancer with an average age (total of their ages divided by 3) less than 40?
If so, was any of them your mother or sister?

20.Have 4 of your family members had breast cancer with an average age (total of their ages divided by 4) less than 50?
If so, was any of them your mother or sister?

21.Have 4 of your relatives on your father's side of the family had breast cancer under the age of 60?

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1. Have you answered yes to any of the questions above?
2. Are relatives with cancer all on one side of the family (either all on your mother’s side or all on your father’s side)?
3. Are they blood relatives of each other and you?

If you have answered yes to the last 3 questions and are worried about your family history of cancer, it may be prudent to see your general practitioner for risk assessment and/or appropriate referral.

REFERENCES:

1. NICE Clinical Guideline 41 Issue date Oct 2006
2. NICE Women with breast cancer in the family-Information about NICE clinical guideline 41: Issue date Oct.2006
3. NICE Clinical Guideline 14 Issue date May 2004
4. UK Breast Cancer incidence statistics: Cancer Research UK (http://info.cancerresearchuk.org/cancerstats/types/breast/incidence/ accessed online 15/08/08)
5. Breast Cancer: Statistics on Incidence, Survival, and Screening: Imaginis-The Woman’s Health Resource (http://www.imaginis.com/breasthealth/statistics.asp accessed online 15/08/08)

ACKNOWLEDGEMENT:

Lynn Horton, Specialist Nurse Practitioner, Breast Unit, Castle Hill Hospital

Firts Published January 2009

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