Family history: Assessing your breast cancer risk

If you’re worried about your family history of breast cancer, you may be eligible for a family history risk assessment.

This assessment will tell you, based on your family history, what your risk of developing breast cancer may be.

You’ll have your risk assessment at a specialist family history clinic or a regional genetics centre, depending on where you live.

You’ll usually need to be referred by your GP. 

You should be referred for a family history risk assessment if:

• 1 first degree relative has had breast cancer before the age of 40 
• 1 first degree male relative has had breast cancer at any age
• 1 first degree relative has had breast cancer in both breasts (bilateral breast cancer) before the age of 50
• 1 first degree or second degree relative has had breast cancer at any age and 1 first degree or second degree relative has had ovarian cancer at any age (at least one needs to be a first degree relative)
• 3 or more first degree or second degree relatives have had breast cancer at any age

First degree relatives include your mother, father, brothers, sisters and your children.

Second degree relatives include aunts, uncles, grandparents, nieces, nephews and half siblings.

You may also be referred if there is breast cancer in your family and:

• You have Jewish ancestry  
• You or a relative has had sarcoma (cancer in the connective tissues, for example in the muscle or bone) before the age of 45 
• You or a relative has had glioma (a type of brain tumour) or childhood adrenal cortical cancer (cancer in the outer layer of the adrenal gland)
• Your family has had a number of cancers at a young age 
• 2 or more relatives on your father's side of the family have had breast cancer

You should be referred directly to a specialist genetics service if you have an inherited altered gene such as BRCA1, BRCA2 or TP53.

It’s completely natural to feel anxious when you’re waiting for a family history risk assessment.

You might find it helps to talk about your worries with family or friends. You can also call our free helpline on 0808 800 6000 to speak with our specialist nurses, or talk to us online.

Try to find out as much about your family history as you can from your relatives before your appointment. 

You may be asked to complete a questionnaire about your family history before being offered an appointment, or you may be asked for this information at your appointment. 

The nurse or genetic specialist looking at your family history will be understanding if you can’t find all the relevant information. 

What you’ll be asked about at your appointment

At the appointment you’ll be asked about any type of cancer in all your blood relatives on both sides of your family. 

This includes your mother and father, sons and daughters, brothers and sisters, aunts and uncles, nieces and nephews, cousins, grandparents, great uncles and great aunts.

You’ll be asked about:

• Your known family history on your mother’s and father’s sides, including family members who have not had cancer, and the age at which any of them died
• How the people diagnosed with cancer are related to you
• How the people diagnosed with cancer are related to each other
• What type of cancer each person had
• How old each person was when diagnosed 
• Whether the same person has had more than 1 cancer (including cancer in both breasts)
• Your ethnic background 
• Whether you have any Jewish ancestry
• Your own breast cancer diagnosis if you’ve been diagnosed

If you don’t have much information about your family history or your blood relatives, your risk assessment will be based on whatever information you have.

At the end of your appointment, if your genetics team has enough information, you’ll be told what your level of risk is based on your family history. Your mother’s and father’s sides of the family will be assessed separately.

There are 3 possible levels of risk for breast cancer:

• General population risk (average or near population risk)
• Moderate risk (familial or raised risk)
• High risk (hereditary or increased risk)

General population risk (average or near population risk)

General population risk means the risk of getting breast cancer is the same as, or very similar to, that of the general population.

1 in 7 women in the UK will develop breast cancer in their lifetime. 

If only 1 person in your family has been diagnosed with breast cancer over the age of 40, you’re likely to be at general population risk. 

Moderate risk (hereditary or raised risk) 

People in this category are at higher risk than the general population. However, it’s still more likely they will not get breast cancer, despite their family history.

If you’re at moderate risk, you may have several close family members with breast cancer but no obvious pattern of the disease. Although breast cancer might affect people in several generations of your family, they tend to be affected at older ages. 

You may also be considered at moderate risk if 1 of your close relatives developed breast cancer under the age of 40.

High risk (hereditary or increased risk)

People in this category are more likely to get breast cancer than those at moderate risk. But this does not mean they definitely will get breast cancer.

If you’re at high risk, you’ll usually have several close family members on your mother’s or father’s side who’ve been diagnosed with breast cancer, ovarian cancer or both over several generations (for example your grandmother, mother and daughter). They’ll usually have been diagnosed at a younger age, often under the age of 50. 

If you’re at general population risk

If you’re told you’re at general population risk, you should be given information about routine breast screening. In the UK, women aged 50 to their 71st birthday are invited for a mammogram every 3 years.

You should also be told about the importance of being breast aware and reporting any possible signs of breast cancer.

It’s important to go back to your GP if your family history changes – for example if another relative develops breast or ovarian cancer.

If you’re at general population risk, you may also be given information on how to reduce your risk through diet and lifestyle changes.

If you’re at moderate risk 

If you’re at moderate risk, you’re likely to be offered regular breast screening. Breast screening for women at moderate risk is offered from the age of 40, which is earlier than routine breast screening.  

Your specialist team may also discuss the possibility of medication to reduce your risk of breast cancer.

It’s important to go back to your GP if your family history changes, for example if another relative develops breast or ovarian cancer.

If you’re at high risk

If you’re at high risk, you’ll be given information on the options available to you, including breast screening and risk-reducing surgery or medication. 

You may be offered genetic counselling, and the possibility of genetic testing will be discussed.

Genetic counselling 

If you’re considered to be at high risk of developing breast cancer, you may be offered a genetic counselling appointment at a regional genetics centre.

Genetic counselling can also be offered if you have an unusual family history or if further investigation into your family history would be helpful to understand your risk.

You’ll meet with a genetic counsellor (a healthcare professional with specialist knowledge of genetics and inherited illnesses) or a clinical geneticist (a doctor with specialist training in genetics).

They can help you understand more about your family history and your risk of developing breast cancer and possibly other cancers.

They can also tell you about the options that may be available to you, such as:

• Genetic testing
• Breast screening 
• Medication to reduce the risk of cancer
• Surgery to reduce the risk of cancer

This may be done over several visits.

It’s completely natural to feel anxious talking about your risk and what this means for you and your relatives. 

Your genetics team will have a lot of experience talking through the issues involved and will be able to offer you support.

Find out more about genetic testing and options to help you manage your breast cancer risk.

Finding out that you’re at moderate or high risk of breast cancer can be a stressful and worrying time, but you don’t have to cope alone. 

All cancer genetics clinics have genetics counsellors who you can talk to about how you’re feeling. 

You can also contact our free helpline for support and information about family history concerns – please see below.

Our Someone Like Me service can also put you in touch with a trained volunteer who has experienced the issues you’re facing, whether you have a family history or you’re considering genetic testing – see below.

You can also talk to people who understand what you’re experiencing on the Family history, genes and cancer section of our online forum.