Breast cancer genetics (A/P-AFF)

Individual from a family in whom a mutation in a cancer predisposition gene has NOT been identified (Adult and Paediatric Conditions in AFFECTED Patients)

Emergency department referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

    Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

    Does your patient wish to be referred?

    Minimum referral criteria

    Does your patient meet the minimum referral criteria?

    Category 1

    Appointment within 30 days is desirable

    • Breast cancer with at least one of the following:
      • distant (outside loco-regional areas) metastatic triple negative disease
      • distant (outside loco-regional areas) metastatic disease with a short-predicted life expectancy
      • results of genetic testing (if offered) will influence systemic treatment considerations
      • Results of Genetic Testing (if offered) will influence local treatment considerations in a patient aged < 60 years
      • age ≤ 40 years and not completed local treatment for breast cancer
      • personal and/or family history of Li Fraumeni associated cancer (other than breast cancer) and could be considered for adjuvant radiation

    Category 2

    Appointment within 90 days is desirable

    • An Individual whose referral to GHQ was recommended after a review of a relative
    • Tumour testing has identified a potential germline mutation in a familial cancer predisposition gene
    • Breast cancer with at least one of the following:
      • a patient who has a limited life expectancy due to advanced age and/or co-morbidities
      • inflammatory with recent active disease (e.g. within the last 3 years)
      • triple negative (TNBC) confined to loco-regional areas with recent active disease (e.g. within the last 3 years)
      • distant (outside loco-regional areas) ER+/PR+ and/or HER2+ metastatic disease

    Category 3

    Appointment within 365 days is desirable

    • Breast cancer that does not meet Category 1 or 2 criteria

    If your patient does not meet the minimum referral criteria

    Consider other treatment pathways or an alternative diagnosis.

    If you still need to refer your patient:

    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

    Other important information for referring practitioners

    Not an exhaustive list

    • The offer of an appointment by Genetic Health Queensland (GHQ) does NOT guarantee that the patient will be offered a publicly funded gene test.
    • Providing information about the timeframe for which genetic consultation and testing (if offered) is required, to assist in ensuring the referral is appropriately prioritised to inform treatment decisions.
    • Due to the lack of evidence for clinical benefit for bilateral mastectomy in women with unilateral breast cancer aged >60 years regardless of genetic test results, local treatment decisions will only be considered justification for triage as a Category 1 for this age group if there is a personal/family history suggestive of Li Fraumeni syndrome.
    • Referral for genetic assessment and counselling is recommended if:
      • breast cancer diagnosed at age < 40 years
      • triple negative breast cancer (TNBC) diagnosed at age ≤ 50 years (TNBC: oestrogen, progesterone and HER2 receptor negative)
      • TNBC at any age AND a personal history of another primary breast cancer
      • TNBC at any age AND a first or second degree relative with breast cancer
      • lobular breast cancer AND a family history of lobular breast or diffuse-type gastric cancer or cleft lip/palate
      • personal history of two primary breast cancers where the first occurred ≤ 50 years
      • personal history of breast and ovarian cancer
      • male breast cancer at any age
      • Jewish ancestry
      • breast cancer and a personal or family history suggestive of:
      •  reported family history of ovarian cancer
      • a Manchester Score of ≥ 15
    • Tumour testing has identified a potential germline mutation in a familial cancer predisposition gene.
    • If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene please refer to the Untested blood relative  condition.
    • If the patient has undergone mainstreamed and/or private genetic testing refer to the Mainstreamed or private testing condition
    • Eligibility for publicly funded genetic testing will be determined using eviQ criteria.
    • If the patient fulfils eviQ criteria for genetic testing and has a very limited life expectancy, arrange for two separate blood collections of 2x4mL EDTA tubes each to be sent to the Molecular Genetics Laboratory, Pathology Queensland (RBWH) for “DNA extraction and storage” prior to or at the time of referral. Advise Pathology Queensland that these specimens have been collected in accordance with Genetics Health Queensland protocols.
    • If at the time of pre-clinic contact assessment, it is established that the reason for clinical urgency detailed in the referral is no longer valid, the triage category will be amended accordingly.
    • Patient will be mailed a family history questionnaire to complete and return. Failure to do so may result in removal of the patient from the waitlist.
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

    Referral requirements

    A referral may be rejected without the following information.

    • As much detail as possible about the patient’s personal history of cancer including the following:
      • type/s of cancer
      • age at diagnosis
      • treatment (completed and planned), including planned time frame of radiation and surgery
      • details of prognosis in patients with metastatic disease
      • relevant pathology (if results are available on Auslab please indicate this on referral)
      • clear indication of clinical indication for urgency (see above)
      • known details of relevant family history
      • time by which genetic tests results required (if offered) to inform local or systemic treatment decisions
    • Relevant pathology (if results are available on Auslab please indicates this on referral)
    • Confirmation of OOHC (where appropriate) and contact details to send correspondence for OOHC

    Additional useful information (useful for processing the referral)

    • Ethnicity of the patient (particularly Jewish or Dutch ancestry)
    • If the family is known to GHQ, include the GHQ reference number (GF) if known


    • General referral information/Standard information (Appendix 2, Consultation overview)
    • Notes
      • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
      • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
      • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

    Out of catchment

    Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander
    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary
    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use
    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander
    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature
    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

    Send referral

    Hotline: 1300 364 938

    Medical Objects ID: MQ40290004P
    HealthLink EDI: qldmnhhs

    Metro North Central Patient Intake
    Aspley Community Centre
    776  Zillmere Road
    ASPLEY QLD 4034

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