Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40–60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40–50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored.

Trial registration: CRUK Clinical Trials Database 11779.

乳腺癌家族史是一个关键的危险因素，占癌症的10%。我们评估了初级保健中家族性乳腺癌 (FBC) 风险的主动评估。符合条件的女性（30 至 60 岁）是从八家英国全科诊所招募的。对 FBC 风险评估的实践进行了培训。在四个随机分配的实践中，女性被邀请完成经过验证的邮寄家族史问卷，实践工作人员将其输入决策支持软件以确定癌症风险。那些风险增加的人被提供专家转诊。在其他四种做法中观察到通常的护理。在干预实践中，1127/7012 名女性（16.1%）返回了家族史问卷，其中包括 1105 名（98%）自我报告的白人种族和 446 名（39.6%）受过大学本科或同等学历的教育，119 (10.6%) 名被确定为乳腺癌风险增加并提供转诊。被推荐转诊的 67 名 (56%) 女性小于 50 岁。在 66 名就诊专科医生的女性中，26 名 (39.4%) 被确认为高风险，建议进行年度监测（40-60 岁）和手术预防；30 人（45.5%）被确认为中等风险，19 人提供年度监测（40-50 年）。其余 10 个 (15.2%) 在初级保健中管理。没有推荐的化学预防。在通常的护理实践中，只有 10 名女性咨询了有关乳腺癌家族史的疑虑。这项研究表明，初级保健中的主动风险评估能够准确识别女性，包括许多年轻女性，她们患乳腺癌的风险增加。为了提高整个人群的普遍性，

试验注册：CRUK 临床试验数据库11779。