Current NHS criteria for breast cancer screening in women under 50 are too narrow, potentially missing up to 95% of those at higher risk of developing the disease, researchers have warned. The National Institute of Health and Care Excellence (Nice) guidelines, which currently govern these checks, focus exclusively on inherited genes, neglecting other significant factors such as lifestyle.
While older women are routinely offered mammogram scans, women under 50 typically do not receive breast screening unless they possess a strong family history of the illness. Breast cancer remains a leading cause of death for women under 50 in the UK.
A new study, published in the British Journal of Cancer by a team from Cambridge University and the Institute of Cancer Research, utilized an advanced risk assessment tool called Boadicea. This calculator integrates various factors including family history, lifestyle, reproductive history, and genetic information to generate a comprehensive risk score. Using this tool, the study identified eight times as many women in the under-50 age group who subsequently developed breast cancer.
The research estimates that if all women under 50 were assessed with the Boadicea tool, approximately a quarter (26.5%) would be categorized as having an above-average risk and referred for further evaluation. This group would encompass nearly a third (34.8%) of women under 50 who go on to develop breast cancer within a decade. In stark contrast, the existing Nice criteria would lead to only 1.4% of women under 50 being referred, capturing just 4.4% of those who later develop breast cancer.
A primary reason for this significant disparity, according to the researchers, is that three-quarters (73%) of women under 50 who develop breast cancer within a decade have no family history of the disease, which is the key criterion in the current Nice guidelines.
Lead researcher Dr. Juliet Usher-Smith urged the NHS to review its criteria in light of these findings. However, she acknowledged that referring more individuals would inevitably increase workloads and could potentially cause some women to undergo unnecessary checks and experience anxiety. Dr. Sowmiya Moorthie, from the charity Cancer Research UK, which funded the study, emphasized that "Any changes must be accessible and equitable, taking into consideration the anxiety that extra referrals might cause for women."
Several breast cancer risk calculators, similar to Boadicea, are already in existence, and none are considered perfect. Nice stated that it welcomed the study's findings and recognized the potential of such multifactorial risk assessment tools. However, the institute concluded that the current evidence does not yet warrant a change to its breast cancer guidelines.
The NHS breast cancer screening programme is subject to regular evaluation by the UK National Screening Committee. It is important to note that about one in seven women will develop breast cancer in their lifetime, yet only 5-10% of cases are linked to inherited genes. Most cases, 96%, occur in women over 40, with 25% in women over 75. Men can also develop breast cancer, with approximately 420 new cases reported annually in the UK.
In England, Nice guidance recommends that GPs inquire about family history if a woman expresses concern about a higher breast cancer risk, and sometimes if she is over 35 and using an oral contraceptive pill or considering hormone replacement therapy (HRT). While hormones have been associated with a slightly increased risk, larger risk factors include alcohol intake and obesity.
All women are encouraged to be aware of what feels normal for their breasts and to consult a doctor if they notice any changes.
