Key facts
- Missed women under 50
- Up to 95%
- Increase in identified at-risk women
- Eight times more
- Women under 50 with no family history
- 73%
- Breast cancer cases linked to inherited genes
- 5-10%
- Lifetime risk for women
- 1 in 7
Background
Breast cancer is the most common cancer worldwide, accounting for about one in four cancer cases, and is a leading cause of death in women under 50 in the UK. About one in seven women develop breast cancer in their lifetime, with only 5-10% of cases linked to inherited genes. Notably, 73% of women under 50 who develop breast cancer have no family history of the disease.
Current guidelines from the National Institute of Health and Care Excellence (NICE) determine which women can be referred for further breast cancer risk assessment and specialist care. These guidelines focus primarily on inherited genes and do not consider other factors such as lifestyle, reproductive history, or genetic information beyond family history. As a result, women under 50 are typically not considered for screening unless they have a strong family history of breast cancer.
Current situation
A new risk assessment system called Boadicea, developed by the University of Cambridge and funded by Cancer Research UK, combines family history, lifestyle, reproductive history, and genetic information. According to the study, this system identified eight times as many women under 50 who would develop breast cancer compared to the current NICE criteria.
The analysis suggests that the criteria given to GPs in England to refer women miss up to 95% of patients under 50 who could develop the disease within a decade, and 95% of women aged under 50 with a higher-than-average risk. Experts believe that identifying those at highest risk earlier would give doctors a better chance to treat or even prevent breast cancer.
Dr Juliet Usher-Smith of the University of Cambridge said: “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. 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.”
| Metric | Value |
|---|---|
| Women under 50 missed by current criteria | Up to 95% |
| Increase in identified at-risk women with Boadicea | Eight times more |
| Women under 50 with no family history | 73% |
| Breast cancer cases linked to inherited genes | 5-10% |
| Lifetime risk for women | 1 in 7 |
Impacts
The findings highlight limitations in the current referral criteria, which could affect thousands of women under 50 in England who are at elevated risk but are not being identified. This means they may miss opportunities for early intervention, including preventive measures or earlier treatment options.
Prof Montserrat García-Closas of the Institute of Cancer Research noted 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. Ultimately, it will be a trade-off between the practical, resource, and cost implications of data collection and risk assessment, and the potential benefits and harms associated with accurate and inaccurate classification of women.”
Dr Simon Vincent, chief scientific officer at Breast Cancer Now, which supported the study, said: “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. However, it’s equally important that any changes come with the needed investment in family history services, so they can be implemented effectively and fairly across the NHS.”
Future outlook
Scenario analysis: The possibilities below are not certain predictions.
A NICE spokesperson said: “Nice welcomes the findings of this study and recognises the potential of multifactorial risk models in improving the identification of women at increased risk of breast cancer in the future. 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.”
If NICE incorporates multifactorial risk models like Boadicea into its guidelines, more women under 50 at high risk could be identified earlier, potentially improving outcomes. However, such a change would require significant investment in data collection, genetic testing, and family history services, as highlighted by experts.
Alternatively, if the criteria remain unchanged, the current gap in identifying at-risk women may persist. The ongoing review of NICE's family history guidelines could provide an opportunity to address these limitations, but any update will depend on further evidence on feasibility and clinical outcomes.
Source: mirror.co.uk
