Evidence

Surveillance report 2018 – Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (2013) NICE guideline CG164

Surveillance decision

Surveillance decision

We will not update the guideline on familial breast cancer at this time.

During surveillance editorial or factual corrections were identified. Details are included in appendix A: summary of evidence from surveillance.

Reason for the decision

Assessing the evidence

We found 30 studies through surveillance of this guideline.

This included evidence that supports current recommendations in the following areas:

  • the accuracy of family history

  • the optimal methods for assessing the carrier probability of people at different thresholds for genetic testing in those at risk of familial breast cancer

  • patient information and support

  • the effectiveness of chemoprevention for the reduction of the incidence of breast cancer in people with a family history of breast, ovarian or related (prostate/pancreatic) cancer

  • risk-reducing mastectomy for women with no personal history of breast cancer

  • risk-reducing oophorectomy for women with no personal history of breast cancer.

We also identified evidence that was not consistent with current recommendations on: BRCA testing of women with epithelial ovarian cancer; mammographic surveillance of women under 40 years; and the efficacy of MRI screening compared to mammography and ultrasound. On further consideration, this evidence was deemed not to impact current recommendations (for further details see appendix A).

We found evidence on the following areas not covered in the guideline:

  • use of a brief screening tool to identify low income women at high risk of breast cancer and to aid referral from primary care

  • telephone-based genetic counselling

  • rapid genetic counselling and testing

  • clinical nurse specialist-led breast self-examination education intervention as part of a surveillance programme

  • associations between breast cancer risk and dietary linoleic acid intake or serum linoleic acid level.

This evidence was considered to be insufficient in volume and conclusive results to add new recommendations in these areas at this time.

We did not find any evidence related to the following areas:

  • communicating cancer risk and carrier probability

  • care and management in primary care

  • patient education and information

  • care and management approach in secondary care

  • the carrier probability at which genetic testing should be offered to people who are (a) unaffected but with a family history of breast, ovarian or related cancer; (b) unaffected with a family history and no living relative; (c) affected patients

  • who should discuss the implications of genetic testing with the patient and when the most appropriate time is for such a discussion to occur

  • the risks and benefits of hormone replacement therapy for women under the age of 50, with a BRCA1 or BRCA2 mutation who have undergone a bilateral salpingo-oophorectomy

  • the level of risk which indicates that risk reducing surgery is a viable option

  • the factors that indicate that offering risk reducing surgery is not appropriate

  • the effectiveness of mastectomy compared with breast conserving surgery plus radiotherapy for people with newly diagnosed breast cancer or high grade ductal carcinoma in situ (DCIS) with a TP53 mutation or at high risk of TP53 mutation.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts and stakeholders, we decided not to update this guideline.

See how we made the decision for further information.


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