The Manchester Scoring System with pathology adjustment
| BRCA1 | BRCA2 | |
| Cancer, age at diagnosis (years) | ||
| FBC, <30 | 6 | 5 |
| FBC, 30–39 | 4 | 4 |
| FBC, 40–49 | 3 | 3 |
| FBC, 50–59 | 2 | 2 |
| FBC, >59 | 1 | 1 |
| MBC, <60 | 5 | 8 |
| MBC, >59 | 5 | 5 |
| Ovarian cancer, <60 | 8 | 5 |
| Ovarian cancer, >59 | 5 | 5 |
| Pancreatic cancer | 0 | 1 |
| Prostate cancer, <60 | 0 | 2 |
| Prostate cancer, >59 | 0 | 1 |
| Pathology adjustment | ||
| Breast cancer (index case only) | ||
| Grade 3 | +2 | 0 |
| Grade 2 | 0 | 0 |
| Grade 1 | −2 | 0 |
| ER positive | −1 | 0 |
| ER negative | +1 | 0 |
| Triple-negative* | +4 | 0 |
| HER2 amplified† | −6 | 0 |
| Ductal carcinoma in situ | −2 | 0 |
| Lobular | −2 | 0 |
| Ovarian cancer (any case in family‡) | ||
| Mucinous, germ cell or borderline tumours | 0 | 0 |
| High-grade serous, <60 | +2 | 0 |
| Adopted (no known status in blood relatives) | +2 | +2 |
Each individual and family characteristic (from one side of the family only) is given a numerical weight and these are added to give a score for each of the two genes, BRCA1 and BRCA2.30 Score ‘Cancer, age at diagnosis’ first and then adjust score based on ‘Pathology adjustment’.
*Also score grade in addition to triple-negative.
†Also score grade and ER status in addition to HER2 status.
‡Only if the relative is not related to index case through more than one unaffected woman aged >60 years.
As an example, a 34 year-old woman diagnosed with ER- HER2 amplified grade 3 invasive ductal carcinoma and a first-degree relative with high-grade endometrioid ovarian cancer diagnosed at 63 years of age would score 4+4+2+1–6+5+5=15 points.
ER, oestrogen receptor; FBC, female breast cancer; MBC, male breast cancer.