Key facts
- UK breast cancer screening guidelines are missing up to 95% of women under 50 who are at higher risk.
- Current guidelines by Nice focus only on inherited genes, excluding lifestyle and other risk factors.
- A study using the Boadicea risk assessment tool identified significantly more at-risk women under 50.
- The Boadicea tool combines family history, lifestyle, reproductive history, and genetic information.
- Researchers estimate 26.5% of women under 50 would be categorized as above-average risk with the new tool.
- A key reason for missed cases is that 73% of women under 50 with breast cancer have no family history.
Current guidelines in the UK for breast cancer screening for women under 50 are considered too restrictive, potentially missing a significant majority of those at higher risk, according to a study published in the British Journal of Cancer. Researchers from Cambridge University and the Institute of Cancer Research found that the National Institute of Health and Care Excellence (Nice) guidelines focus predominantly on inherited genetic factors, overlooking crucial lifestyle and reproductive history elements that contribute to breast cancer risk in younger women.
The study utilized a new risk assessment tool called Boadicea, which integrates a broader range of factors including family history, lifestyle choices, reproductive patterns, and genetic information to generate a risk score. The researchers estimate that if all women under 50 were assessed with Boadicea, approximately 26.5% would be identified as being at above-average risk and warranting further investigation. This is a stark contrast to the current Nice criteria, which would only refer about 1.4% of women in this age group for additional assessment.
A significant finding highlighted by the study is that three-quarters of women under 50 who develop breast cancer within a decade have no prior family history of the disease, underscoring the limitations of the current screening approach. Lead researcher Dr Juliet Usher-Smith suggested that the NHS should re-evaluate its screening criteria in light of these findings. However, she acknowledged that expanding screening could increase workloads and potentially cause unnecessary anxiety for some women.
Dr Sowmiya Moorthie from Cancer Research UK, which funded the research, emphasized the need for any potential changes to be accessible and equitable, while also considering the psychological impact of increased referrals. Nice stated that while they welcome the findings and recognize the potential of multifactorial risk assessment tools, the current evidence does not yet support a change to their existing breast cancer guidelines. The NHS breast cancer screening program is subject to regular evaluation by the UK National Screening Committee, and all women are encouraged to be aware of any changes in their breasts and consult a doctor if they notice anything unusual.