This familial breast cancer guideline doesn't change anything for us. Our role is to risk assess women and refer on to the genetics services if they may be at high risk. NICE do say that this shouldn't be screening, but a response to a concerned woman, or if there seems to be a significant history on doing a pill or HRT check.
Also of interest is that 'TP53' is now tested for, alongside BRCA1 and 2
How to do a familial breast cancer risk assessment
This hasn't changed from the last guideline. There was a handy flowchart in the last guideline, which I keep printed out to use.
Combined oral contraceptive (COC) use
The COC can be used until age 35, even if there is a family history of breast cancer. After age 35, the breast cancer risk must be discussed. For women with a BRCA1 mutation, there may be some protection from ovarian cancer with the COC, though they do not advise using the pill solely for this reason. Despite this NICE advice, having a known mutation remains a UKMEC3 criteria.
HRT can be used in women with a family history, but the risks must be discussed. As always, it should be used for the shortest time possible and at the lowest dose. In women at high or moderate risk (as stratified by the genetics service), use should be confined to the under 50s. Oestrogen only HRT is preferred if appropriate.
Something we may start to see is that this guideline advises the use of 5 years of tamoxifen or raloxifene in at risk women.