RACGP Crest

Guidelines for preventive activities in general practice 7th edition

Skip to content
Large font
Medium font
Small font

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Download the full PDF version of Guidelines for preventive activities in general practice 7th edition (396Kb)

 

Breast cancer

Breast cancer age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
                    X X X X    

For women at average risk and aged 50–69 years, screening by mammogram every 2 years is recommended (A). For women who are eligible and attending for regular mammographic screening, there is no evidence that clinical breast examination will provide additional benefit (E). Mammographic screening is not recommended for women at average risk under 40 years of age. All women should be advised to be familiar with the normal look and feel of their breasts and to report any new or unusual changes to their GP without delay. No specific technique is promoted for breast self examination as there is no evidence of the effectiveness of any one approach. The breast awareness approach should be seen as a supplement to, not a substitute for, regular mammograms in women within the target age range for screening.390

Breast cancer risks
Who is at higher risk of breast cancer? What should be done? How often? Level of evidence and references
Average risk or slightly above (>95% of the female population)
  • No confirmed family history of breast cancer
  • One first degree relative diagnosed with breast cancer at age 50 years or over
  • One second degree relative diagnosed with breast cancer at any age
  • Two second degree relatives on the same side of the family diagnosed with breast cancer at age 50 years or over
  • Two first or second degree relatives diagnosed with breast cancer at age 50 years or over, but on different sides of the family (ie. one on each side of the family)

As a group, lifetime risk of breast cancer is between one in 11 and one in 8. This risk is no more than 1.5 times the population average




Mammogram


Breast awareness


Every 2 years from 50-69 years of age*




Regular


I A 391-396
Moderately increased risk (<4% of the female population)
  • One or two first or second degree relatives diagnosed with breast cancer before the age of 50 years (without the additional features of the potentially high risk group)
  • Two first degree relatives on the same side of the family diagnosed with breast cancer (without the additional features of the potentially high risk group)
  • Two second degree relatives on the same side of the family diagnosed with breast cancer, at least one before the age of 50 years (without the additional features of the potentially high risk group)

As a group, lifetime risk of breast cancer is between one in 8 and one in 4.
This risk is 1.5–3.0 times the population average



Mammogram


Breast awareness


Consider referral to, or consultation with, a family cancer clinic for further assessment

At least every 2 years from 50-69 years of age*

III C 391
Potentially high risk (<1% of the female population)
  • Women who are at potentially high risk of ovarian cancer (see Category 3 below)
  • Two first or second relatives on one side of the family diagnosed with breast or ovarian cancer plus one or more of the following features on the same side of the family:
    • additional relative(s) with breast or ovarian cancer
    • breast cancer diagnosed before the age of 40 years
    • bilateral breast cancer
    • breast and ovarian cancer in the same woman
    • Ashkenazi Jewish ancestry
    • breast cancer in a male relative
  • One first or second relative diagnosed with breast cancer at age 45 years or less plus another first or second relative on the same side of the family with sarcoma (bone/soft tissue) at age 45 years or less
  • Member of a family in which the presence of a high risk breast cancer gene mutation has been established
  • Three or more first or second degree relatives on the same side of the family diagnosed with any cancers associated with hereditary nonpolyposis colorectal cancer (HNPCC): CRC (particularly if diagnosed before the age of 50 years), endometrial, ovarian or gastric cancers, and cancers involving the renal tract
  • A woman suspected to have HNPCC
  • Member of a family in which the presence of a high risk breast cancer gene mutation has been established

Women in high risk groups may carry BRCA1 or BRCA2 or other gene mutations. Women who carry BRCA1 and BRCA2 mutations are at high risk of developing breast cancer and ovarian cancer

See the National Breast Cancer Centre (NBCC) guidelines. Available at www.nbcc.org.au for further information

As a group, lifetime risk of breast cancer is between one in 4 and one in 2. Risk may be more than three times the population average. Individual risk may be higher or lower if genetic test results are known



Advise referral to a cancer specialist or family cancer clinic for development of an individualised surveillance program




This may include clinical breast examination, mammography and/ or ultrasound and surveillance for ovarian cancer

Individualised surveillance program

III C 391
For all women there is a chance that mammography will either miss a change due to breast cancer (false negative) or that further tests will be performed to examine a change that is not due to breast cancer (false positive). The chance of a false negative or false positive result is higher in younger women because their breast tissue is more dense. Women 40–49 years of age should be advised that the benefits of mammographic screening increase with increasing age. Women in this age group are more likely to be recalled for additional assessment and investigation.392,393 Women in this age group should balance the benefits and downsides of mammographic screening for them. Breast cancer remains common and can be readily detected by mammography in women over 70 years of age. With increasing life expectancy some women may elect to continue regular mammographic screening to an age decided in consultation with their doctor having regard to comorbidities and life expectancy394

Strategies
A recent systematic review of strategies for increasing the participation of women in community breast cancer screening found five active strategies for inviting women into community breast cancer screening services to be favourable: letter of invitation, mailed educational material, letter of invitation plus phone call, phone call, and training activities plus direct reminders.401 Physical activity is associated with a reduced risk of breast cancer.397 Studies have shown a 20–40% reduction in risk of breast cancer in both pre- and post-menopausal women.398

Back to top

© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook