Instructions:
1. Assign a score to the patient and all their cancer affected family members using the table below.
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.
|
Score |
Proband's score
(pathology adjustment breast and ovarian) |
Relatives' scores
(pathology adjustment ovarian only) |
Cancer (age at diagnosis) NB: count invasive breast cancer & DCIS; do not count LCIS |
Female breast cancer <30 years |
11 |
|
|
Female breast cancer 30 - 39 years |
8 |
|
|
Female breast cancer 40 - 49 years |
6 |
|
|
Female breast cancer 50 - 59 years |
4 |
|
|
Female breast cancer >59 years |
2 |
|
|
Male breast cancer <60 years |
13 |
|
|
Male breast cancer >59 years |
10 |
|
|
Epithelial ovarian cancer (any grade) <60 years |
13 |
|
|
Epithelial ovarian cancer (any grade) >59 years |
10 |
|
|
Pancreatic cancer |
1 |
|
|
Prostate cancer <60 years |
2 |
|
|
Prostate cancer >59 years |
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 |
1 |
|
no adjustment needed |
Triple negative |
4 |
|
no adjustment needed |
HER2 positive |
-6 |
|
no adjustment needed |
Ovarian cancer pathology adjustment (for all cases in the family) |
High grade serous <60 years |
2 |
|
|
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 |
|
|
Key: |
LCIS: lobular carcinoma in situ |
DCIS: ductal carcinoma in situ |
ER: oestrogen receptor |
Triple negative: oestrogen, progesterone and HER2 receptor -ve |
HER2: human epidermal growth factor receptor 2 |
|
Notes: |
- In a UK based population a score of 15 or higher equates to a pathogenic variant probability of ≥10%
- Manchester scoring has not been specifically validated for individuals affected with cancers other than breast or ovarian, or for unaffected individuals
- If age is uncertain use a best estimate. If age is unknown use >59 years
- Bilateral breast cancer is counted separately (i.e. assign a score for each breast cancer)
- If a relative has had more than one primary cancer, assign a score for each cancer episode
- Only primary cancers are included, not recurrence or secondary cancers
- 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)
|