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Referrals for BRCA1, BRCA2 gene and PALB2 carriers aged between 25 and 29 years must include evidence of risk, using an NHS endorsed computer risk modelling software programme as detailed above, to be accepted into the very high risk programme. at 12 months from the date of the STR attendance, if the woman’s routine screening protocol ( MRI and/or mammogram) is repeated at the STR appointment

New version of the breast screening referral form for women at very high risk. Expanded information requirements in section B. Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba B, Fairweather-Tait S. Calcium requirements of lactating Gambian mothers: Effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr. 1995;62:58–67. a genetics service by a consultant clinical geneticist, genetic counsellor or an appropriately trained individual nominated by them

The national breast screening system ( NBSS) manages the invitation process and records all outcomes for women screened through the very high risk programme. Breast screening services should not use NBSS for the management of family history women identified to be outside the NHS BSP very high risk programme. Although the literature has confirmed the influence of method of infant feeding on body composition in later life, the relationship between being breastfed and bone mineral mass is complex. In this review, the studies that found positive effects of being breastfed (regardless of exclusivity or duration) on BMC and/or BMD showed that formula-fed children had lower bone mass compared to those fed with breast milk [ 5– 8]. Human milk contains lower levels of the nutrients essential for bone mineralization, such as calcium, phosphorus and vitamin D [ 7], compared to infant formulas and other types of milk. Notwithstanding, there are several explanations for the beneficial effect of breast milk, namely: (1) despite the lower concentration of calcium and phosphorus in human milk, the bioavailability and absorption of these nutrients is greater than other types of milk [ 7]; (2) consumption of breast milk results in the intake of 200 mg of calcium per day on average [ 20- 22], a sufficient amount to promote good skeletal development during infancy, which can persist into later life; and also, (3) the potentiating effect of breast milk on bone development may stem from a non-nutritional factor [ 19]. Furthermore, early exposure to breast milk, albeit for a brief period, can lead to changes in the programming of bone cells, resulting in greater bone mass in later life [ 23].

do not routinely offer ultrasound surveillance to women at moderate or high risk of breast cancer but consider it:Nourish Your Body: The biggest thing I’ve learnt is that your diet impacts your hair and it’s important to ensure you eat protein and vitamin-rich foods. Fewtrell MS, Kennedy K, Murgatroyd PR, Williams JE, Chomtho S, Lucas A. Breast-feeding and formula feeding in healthy term infants and bone health at age 10 years. Br J Nutr. 2013;110(6):1–7. World Health Organization. WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. In: WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. Geneva: World Health Organization; 2007. Morley R, Lucas A. Influence of early diet on outcome in preterm infants. Acta Paediatr. 1994;405:123–6. Women covered by this guidance should have both procedures up to and including the age of 50. At the screen when the woman is aged between 50 and before her 51st birthday, breast density should be reviewed by the reporting image reader at the time of her breast screening. If the mammogram shows an entirely fatty breast (BI-RADS A, see the BI-RADS Atlas - Reporting System), MRI is unlikely to add value and her screening protocol should change to mammography only for the remainder of her screening invitations. The review is undertaken by one image reader and the outcome recorded on NBSS. The breast density measurement can also be reported using an automated tool which can measure density giving a BI-RADS score. If there is uncertainty over the category of breast density, a further image reader should be consulted.