Many women under 50 who are at risk of breast cancer are not getting the necessary checks, as current guidelines mainly focus on inherited genes, neglecting other important factors like lifestyle. This leads to a significant number of younger women being excluded from routine mammogram screenings, unless they have a strong family history of the disease.
A new risk assessment tool called Boadicea, developed by Cambridge and funded by Cancer Research UK, takes into account various factors such as family history, lifestyle, reproductive history, and genetic information. This tool has been successful in identifying eight times more women under 50 who are likely to develop breast cancer compared to the current guidelines.
The existing criteria set by the National Institute of Health and Care Excellence (NICE) to determine who should undergo further breast cancer risk assessment and specialist care is failing to detect the majority of younger women who will develop the disease in the next decade. This has prompted calls for a review of the current criteria.
Breast cancer is a prevalent form of cancer globally, responsible for approximately one in four cancer cases and a significant cause of mortality in women under 50. In the UK, about one in seven women will develop breast cancer during their lifetime. Surprisingly, only a small percentage of cases are attributed to inherited genes, with the majority of women under 50 who develop breast cancer having no family history of the disease.
An analysis indicates that the criteria given to general practitioners in England miss up to 95% of women under 50 who could potentially develop breast cancer within ten years, including those with a higher-than-average risk. Identifying these high-risk individuals earlier could greatly improve treatment outcomes and possibly prevent the disease.
Dr. Juliet Usher-Smith from the University of Cambridge emphasized the need to enhance the identification of women at highest risk of breast cancer for better intervention opportunities. The current NICE criteria are failing to identify a significant portion of women under 50 who are likely to develop breast cancer, urging a reevaluation of the guidelines.
Prof. Montserrat GarcÃa-Closas from the ICR highlighted the challenge of balancing the practicality and resource implications of implementing full risk assessments, including genetic testing, against the potential benefits of accurately identifying at-risk women. There is a need to consider the trade-offs between data collection, risk assessment, and the associated costs.
Dr. Simon Vincent, chief scientific officer at Breast Cancer Now, supported the study’s findings, emphasizing the limitations of the current NICE referral criteria. He stressed the importance of incorporating the research results into the ongoing review of family history guidelines, coupled with the necessary investment in family history services within the NHS.
A spokesperson from NICE acknowledged the study’s findings and the potential of multifactorial risk models in improving the identification of women at increased risk of breast cancer in the future. However, they stated that the current evidence does not warrant an immediate change to the existing familial breast cancer guideline, with a commitment to review new evidence for potential updates in the future.
