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    Long-Term evaluation of women referred to a breast cancer family history clinic (Manchester UK 1987-2020)

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    Authors
    Howell, Anthony
    Gandhi, Ashu
    Howell, Sacha J
    Wilson, M.
    Maxwell, A.
    Astley, Susan
    Harvie, M.
    Pegington, M.
    Barr, L.
    Baildam, A.
    Harkness, E.
    Hopwood, P.
    Wisely, J.
    Wilding, A.
    Greenhalgh, R.
    Affen, J.
    Maurice, A.
    Cole, S.
    Wiseman, J.
    Lalloo, F.
    French, D. P.
    Evans, D Gareth R
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    Affiliation
    Nightingale Breast Screening Centre & Prevent Breast Cancer Unit Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    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.
    Citation
    Howell A, Gandhi A, Howell S, Wilson M, Maxwell A, Astley S, et al. Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987-2020). Cancers (Basel). 2020;12(12).
    Journal
    Cancers
    URI
    http://hdl.handle.net/10541/623639
    DOI
    10.3390/cancers12123697
    PubMed ID
    33317064
    Additional Links
    https://dx.doi.org/10.3390/cancers12123697
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.3390/cancers12123697
    Scopus Count
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