Table 4 Recommendations.

Standardised national service

 1

There should be a national strategy for risk assessment and management, ensuring a standardised approach for all.

 2

Additional screening for women at moderate and high risk should be incorporated within the NHS Breast Screening Programme.

 3

There is a need for a national register with centrally stored data for women at above-population-level risk.

 4

There should be flexible and accessible digital tools alongside the offer of support or paper versions to improve access to risk assessment.

 5

There is an emerging need for shifting towards a proactive system to improve equity of access to risk assessment.

 6

Consideration should be given to offering risk assessment within NHS Health Checks, at cervical screening, via religious or community groups and when women present to secondary care with breast symptoms.

 7

Moderate-risk women should be managed by specialist secondary care clinics and high-risk women should be managed between those clinics and CGS.

 8

There is a need for clear shared-care pathways for counselling and initiation of preventive medication.

 9

Funding should be prioritised to enhance capacity in family history clinics, screening, CGS and secondary care.

 10

Ensure clinicians in primary care and those in secondary care, seeing women with breast symptoms, have access to training around risk assessment and management.