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Recommended Referral Criteria & Form

Recommended referral criteria

Any women concerned about her family history should be referred for a comprehensive risk assessment, and screening recommendations; particularly those diagnosed under the age of 40

Clients with a personal history of breast cancer AND one of the following meet criteria for genetic testing:

  • Jewish Ancestry
  • Diagnosed < 40 years
  • Diagnosed < 60 years AND triple negative
  • Ovarian cancer diagnosis
  • Bilateral breast cancer
  • Male breast cancer
  • Significant family history:

- 2+ relatives diagnosed with breast cancer

- Relative with ovarian cancer

- Relative with male breast cancer

  • Unaffected women with a FDR meeting the above criteria

If your patient has Private Medical Insurance please click here to assess if your patient is likely to be covered.

 
 
Referral to (if known):
Clients's Details
Clients's titles*
Clients's first name *
Clients's last name *
Clients's email *
Clients's postcode *
Clients's address 1*
Clients's address 2
Clients's city *
Clients's date of birth
Clients's telephone *
Routine/Urgent
Reason for referral *
Consultant Details
Your name + title
Your telephone
Your email
Hospital/Clinic
Message/Question:
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* Mandatory field
Genetic Counselling Services
If you have a family history of cancer
Complete a referral
Refer a patient or yourself
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