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Guidance: Breast screening: very high risk women surveillance protocols

Nhs England

May 4
15:59 2023

Breast screening referral form for women at very high risk

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Healthcare professionals working in the NHS breast screening programme should use these protocols.

They apply to women referred to the screening programme with a very high risk of developing breast cancer.

Complete the referral form when referring a woman to breast screening because she has been clinically identified as being at higher risk of developing breast cancer. It can be completed electronically or printed out and completed manually.

Contact the screening helpdesk with any queries about this publication, making sure you include its full title.

Published 1 June 2013
Last updated 4 May 2023 +show all updates
  1. Minor amend in the 'Referrals by clinical genetics services or oncology centres' section of the HTML doc.

  2. Updated 'Protocols for the surveillance of women at higher risk of developing breast cancer' and the referral form to clarify: which cohort of women is entitled to very high risk screening following radiotherapy to sites involving breast tissue (formerly referred to as supra-diaphragmatic radiotherapy); the breast density review process; the interval to next screening appointment following a short term recall episode; screening during pregnancy and lactation; and screening transgender and non-binary people.

  3. New version of the breast screening referral form for women at very high risk. Expanded information requirements in section B.

  4. Updated 'Breast screening referral form for women at very high risk' following an update in the breast screening IT system.

  5. Change to the referral form for women at very high risk. Added a section about a womans previous history of breast surgery.

  6. Update to section 3, to include treating clinician referral to very high risk screening for patients carrying a genetic mutation meeting the eligibility criteria.

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