To see all protocols that comply with the WHO Essential Medicine List 

Cancer (age at Dx) 

count invasive Breast Ca & DCIS; do not count LCIS
Score Proband's score 

(pathology adjustment breast and ovarian)

Relatives' scores 

(pathology adjustment ovarian only)

Female Breast Ca <30 11    
Female Breast Ca 30 - 39 8    
Female Breast Ca 40 - 49 6    
Female Breast Ca 50 - 59 4    
Female Breast Ca >59 2    
Male Breast Ca <60 13    
Male Breast Ca >59 10    
Epithelial ovarian (any grade) <60  13    
Epithelial ovarian Ca >59  10    
Pancreatic Ca 1    
Prostate Ca <60 2    
Prostate Ca >59 1    
Adjust for breast cancer histology (for index case only) 
DCIS only  -2   no adjustment needed 
Lobular histology -2   no adjustment needed 
Adjust for grade and receptors (for index case with ductal cancer or DCIS only) 
Grade 3 2   no adjustment needed 
Grade 2  0   no adjustment needed 
Grade 1  -2    no adjustment needed 
ER positive  -1    no adjustment needed 
ER negative    no adjustment needed 
Triple negative    no adjustment needed  
HER2 positive  -6    no adjustment needed 
Ovarian cancer pathology adjustment (for all cases in the family)
High grade serous <60     
Do NOT score mucinous, germ cell, borderline  score 0    
Adjustment for lack of family history (adjust once only) 
Adopted or no knowledge of blood relatives  4   no adjustment needed 
  Total  A=  B= 
Patient's Manchester Score  add A + B    
1. Assign a score to the patient and all their cancer affected family members, using the table above. 
2. Use the pathology adjustment table to adjust the breast and/or ovarian score for the patient being assessed for testing and for any relative with epithelial ovarian cancer; do not pathology adjust for any other relatives.  
3. Starting with the patient being assessed for testing, add the scores assigned to the patient and all blood relatives who are in the same direct lineage (i.e. on the same side of the family); stop counting when history passes through 2 unaffected females who are >60 years. It is easier to do this if you draw the family tree. 


  • Bilateral breast cancer is counted separately (i.e. assign a score for each breast cancer)
  • DCIS is included as breast cancer (all cases) 
  • For invasive ductal breast cancer and DCIS adjust histology, grade and receptors for the index case only; e.g. grade 3 triple negative = +2 for G3 and +4 for TN  
  • LCIS is not included as breast cancer; no grade or receptor adjustment is made for invasive lobular breast cancer 
  • Only score epithelial ovarian cancer; do not score mucinous, germ cell or borderline ovarian tumours 
  • In the case of bilinear family history, the highest score from either side is used (do not add together) 
  • In a UK based population a score of 15 or higher equates to a pathogenic variant probability of >10%
LCIS: lobular carcinoma in situ DCIS: ductal carcinoma in situ
ER: Oestrogen receptor Triple negative: oestrogen, progesterone and Her2 receptor -ve

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26 Jan 2020