Assess women with:

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❑ No previous diagnosis with BRCA related cancer, and
❑ Absence of signs and symptoms of any BRCA related cancer

Risk assessment: is ANY of the following history factors present?

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❑ Family members with breast, ovarian, tubal or peritoneal cancer
❑ Breast cancer diagnosis before age of 50 years
❑ History of bilateral breast cancer
❑ Presence of both breast and ovarian cancer
❑ Breast cancer in one or more male family members
❑ Multiple breast cancer cases in the family
❑ One or more family members with two primary types of BRCA related cancers
❑ Ashkenazi Jewish ethnicity

Yes?

Screening with ANY of the following:

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❑ Ontario Family History Assessment Tool
❑ Manchester Scoring System
❑ Referral Screening Tool
❑ Pedigree Assessment Tool
❑ FHS-7

High risk of potentially harmful BRCA mutation based on screening?

Genetic counseling

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❑ Risk assessment for presence of potential BRCA mutation
❑ Educating patients about the possible genetic testing results
❑ Risk assessment of family members to identify suitable candidates for genetic testing
❑ Discussion about risk reducing interventions
❑ Post-test counseling