Breast cancer screening is failing to identify up to 95% of women under 50 who are at high risk of developing the disease, according to a new analysis. The current guidelines, set by the National Institute for Health and Care Excellence (NICE), focus primarily on inherited genes and often overlook other crucial factors such as lifestyle, meaning many younger women are not referred for screening unless they have a strong family history of breast cancer.
Boadicea tool identifies eight times more at-risk women
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. This approach identified eight times as many women under 50 who would go on to develop breast cancer compared to the current NICE criteria.
The NICE criteria are used by GPs in England to decide who should be referred for further breast cancer risk assessment and specialist care. However, the analysis suggests these criteria miss up to 95% of patients under 50 who could develop the disease within a decade, as well as 95% of women under 50 with a higher-than-average risk.
Experts call for urgent review
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.”
Breast cancer is the most common type of cancer worldwide, accounting for about one in four cases of cancer, and is a leading cause of deaths 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.
Balancing implementation and resources
Prof Montserrat García-Closas, of the Institute of Cancer Research (ICR), highlighted the challenges: “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. 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, who 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.”
NICE responds
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.”
