A significant number of women under 50 who are at risk of breast cancer are not being included in screening programs, with up to 95% of them being overlooked. While women over 50 are routinely offered mammogram checks for cancer detection, the current guidelines by the National Institute of Health and Care Excellence (NICE) primarily focus on genetic factors, neglecting other important aspects like lifestyle. This exclusion results in many women under 50 not being considered for breast screenings unless they have a strong family history of the disease.
To address this gap, a new risk assessment tool named Boadicea, developed by Cambridge and funded by Cancer Research UK, has been introduced. Boadicea considers various factors such as family history, lifestyle choices, reproductive history, and genetic information. This new system has proven to identify eight times more women under 50 who are likely to develop breast cancer compared to the current guidelines.
The existing NICE criteria, used to determine referrals for further breast cancer risk assessment and specialized care, have been ineffective in identifying the majority of women under 50 who are at risk of developing the disease in the next decade. This has led to calls for a review of the current criteria to ensure better inclusivity and accuracy in identifying high-risk individuals.
Breast cancer is a prevalent form of cancer globally, accounting for approximately one in four cancer cases and being a leading cause of death in women under 50 in the UK. Despite only 5-10% of cases being associated with inherited genes, 73% of women under 50 who develop breast cancer have no family history of the disease.
The current guidelines for general practitioners in England have been found to miss out on up to 95% of women under 50 who may develop breast cancer within ten years, as well as 95% of women under 50 with an above-average risk. Experts suggest that early identification of those at highest risk could significantly improve the chances of successful treatment or even prevention of breast cancer.
Dr. Juliet Usher-Smith from the University of Cambridge emphasizes the need for better identification of women at high risk to enable early intervention for effective disease management. The current NICE criteria have been found to overlook a large percentage of women under 50 who are likely to develop breast cancer, underscoring the importance of reassessing the criteria in light of recent findings.
Prof. Montserrat García-Closas from the ICR highlights the challenge of balancing the practicality and resource implications of implementing full risk assessments, including genetic testing, against the potential benefits and drawbacks of accurate risk classification for women.
Dr. Simon Vincent, Chief Scientific Officer at Breast Cancer Now, supports the study findings, emphasizing the limitations of the current NICE referral criteria and the necessity of incorporating these research insights into the ongoing review of family history guidelines.
While NICE acknowledges the potential of multifactorial risk models in enhancing the identification of women at increased risk of breast cancer, there is currently no evidence to warrant a change in the existing familial breast cancer guideline. NICE remains committed to evaluating new evidence and will consider updates as more data on feasibility and clinical outcomes become available.