Introduction

Setting criteria for referral to a clinic requires a clear view of the purpose of the clinic for which the criteria are being set. This chapter will review the current approaches to assessing and managing breast cancer risk and will attempt to put these approaches into the context of the available evidence regarding clinical effectiveness.

Background

Primary care and breast cancer units have found themselves besieged by women who are worried about their risk of breast cancer. The origins of this worry may be media driven, family driven or physician driven and may be appropriate (in those at high genetic risk) or inappropriate. In response to public demand for risk management options, many ‘family history’ clinics have sprung up throughout western Europe, offering breast screening to women who present with concerns about breast cancer risk, usually in this circumstance based on a family history of the disease. Breast screening mammograms with or without physical examination are the measures usually aimed at early breast cancer detection. There are no large scale randomized trials of breast screening in women who are under 50 years of age and at increased genetic risk of breast cancer. There are a small number of reported cohort studies involving relatively small numbers that indicate that breast cancer can be successfully detected at early stages in women under 50 who undergo regular screening examinations (Kollias et al., 1998; Lalloo et al., 1998; Møller et al., 1998; Kerlikowske et al., 2000; Tilanus-Linthorst et al., 2000).