What are the current guidelines for referring a male patient with suspected breast cancer to secondary care?

Referral of a male patient with suspected breast cancer to secondary care should be made urgently. Any male with a first-degree relative diagnosed with breast cancer at any age, or a male patient himself with suspected breast cancer, should be referred to secondary care for further assessment and management.

Specifically, the presence of male breast cancer in the family history is a key criterion for referral. A male patient with suspected breast cancer or a family history including male breast cancer at any age should be offered referral to secondary care or a specialist genetic clinic as appropriate.

Referral criteria include:

• Any male breast cancer at any age in the family.
• One first-degree male relative diagnosed with breast cancer at any age.
• One first-degree relative with bilateral breast cancer where the first primary was diagnosed under 50 years.
• Two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age.
• One first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one must be first-degree).
• Three first-degree or second-degree relatives diagnosed with breast cancer at any age.

In addition, if the family history includes male breast cancer, advice should be sought from the designated secondary care contact, especially if the history is complicated or unusual.

Referral to a specialist genetic clinic is indicated if there is male breast cancer in the family along with other risk factors such as relatives diagnosed with breast cancer under 50 years or multiple affected relatives.

Secondary care management should be multidisciplinary and include access to genetic counselling, risk assessment, and appropriate surveillance or treatment options.

Written information should be provided to the patient about the referral process and what to expect in secondary care.

These recommendations are based on the NICE guideline CG164 on familial breast cancer and related risks.