Breast Cancer Screening Misses Under-50s at High Risk

Researchers at the University of Cambridge and The Institute of Cancer Research, London, claim the vast majority of breast cancer cases in young women are going missed by the NHS.

Dr. Juliet Usher-Smith stated, "The current NICE criteria used in general practice are missing up to 95% of women under 50 who will go on to develop breast cancer. It’s time to look again at these criteria in the light of our findings."

The current NICE guidelines primarily focus on inherited genes; they do not consider other factors such as lifestyle. This means women under 50 are typically not considered for breast screening unless they have a strong family history of the disease.

In contrast, the BOADICEA risk model, a comprehensive risk assessment tool developed at the University of Cambridge, incorporates lifestyle, reproductive history, and genetic information. It offers a more comprehensive assessment.

Just five per cent of young women diagnosed with breast cancer within the next decade had been eligible for referral under current NICE guidelines, researchers claim.

While only 1.4 per cent of women who went on to develop breast cancer were caught by the NICE model, 26.5 per cent were correctly identified by the BOADICEA criteria.

Experts claim that using the new BOADICEA risk assessment system, which combines factors such as family history, lifestyle, reproductive history, and genetic information, identified eight times as many women in the age group who developed breast cancer.

Analysis suggests that using the BOADICEA model for all women under 50 would lead to 26.5% being classed as above-population level risk and referred for further assessment. This includes almost 35% of women under 50 who develop breast cancer within a decade.

Dr. Juliet Usher-Smith emphasized, "We need to get better at identifying women at highest risk of breast cancer so that we can intervene early, when there are more options for treating, or even preventing, their disease."

However, changing the criteria to offer the full BOADICEA risk assessment to all women under 50 would be far more costly and lead to more referrals. Many of these individuals will not develop breast cancer, researchers claim.

Montserrat García-Closas noted, "There will be a balance to strike: the NICE criteria are much easier to implement, but miss a large proportion of women at elevated risk. But a full risk assessment including genetic testing will place a heavy burden on resources."

A NICE spokesperson welcomed the study's findings. They stated, "Nice welcomes the findings of this study and recognizes the potential of multifactorial risk models in improving the identification of women at increased risk of breast cancer in the future."

However, the spokesperson also added, "However, the current evidence does not warrant a change to our existing familial breast cancer guideline at this time. Nice remains committed to reviewing new evidence and will consider further updates as more data on feasibility and clinical outcomes become available."

Simon Vincent highlighted the importance of the research. He stated, "These findings highlight the limitations of NICE's current referral criteria, and so this research must now be carefully considered as part of the current review of its family history guidelines."

Vincent also stressed that "any changes come with the needed investment in family history services, so they can be implemented effectively and fairly across the NHS."

All women are encouraged to be aware of what is normal for them and to consult a doctor if they notice any changes, regardless of current screening guidelines.