NHS misses 95pc of breast cancer cases in young women

Nice guidance refers just 4.4pc of those under 50 who go on to develop the disease within a decade, study finds.

Article by Michael Searles Deputy Health Editor (Telegraph UK)

The NHS is failing to refer up to 95 per cent of women under 50 who go on to develop breast cancer for further checks, new research has revealed.

Just 4.4 per cent of women under 50 who were diagnosed with breast cancer within 10 years met criteria for further checks under existing NHS guidance.

The analysis compared the referral criteria, which are set by the National Institute for Health and Care Excellence (Nice), to a new risk assessment tool, known as Boadicea, which looks at multiple factors including family history, reproductive history, lifestyle and genetics.

Experts from the University of Cambridge, where the tool was developed, said the new model correctly identified eight times as many women who went on to develop breast cancer as current Nice criteria.

Breast cancer is one of the leading causes of death in women under 50 in the UK, and those at higher risk are referred by their GP for further assessment and specialist care.

Researchers analysed data from 1,258 women under 50 who took part in the Breast Cancer Now Generations Study between 2004 and 2011.

The study, published in the British Journal of Cancer, suggested that using the Boadicea model for all women under 50 would lead to 26.5 per cent being classed as above-average risk and referred for further assessment.

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This included almost 35 per cent of women under 50 who developed breast cancer within a decade.

Meanwhile, researchers found the current Nice criteria would result in 1.4 per cent of women being referred for tests, including 4.4 per cent who went on to develop breast cancer.

Dr Juliet Usher-Smith, of the department of public health and primary care at 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 per cent 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.”

UK lags behind in cancer league tables

Dr Simon Vincent, the chief scientific officer at Breast Cancer Now, which supported the study, said the results “highlight the limitations of Nice’s current referral criteria”.

“This research must now be carefully considered as part of the current review of its family history guidelines,” he added.

Routine screening for breast cancer is only available for women aged 50 to 71. Some countries such as the US, Japan, and Sweden begin screening from age 40.

The UK continues to lag behind other developed countries in cancer league tables.

Breast cancer accounts for about 15 per cent of all cancer deaths among women in Organisation for Economic Co-operation and Development (OECD) countries.

It has been falling but remains higher than average in the UK, accounting for 27 deaths per 100,000 women in 2021, versus the OECD average of 25 per 100,000 in 2023.

Japan has one of the lowest mortality rates at 15 deaths per 100,000 women, with experts suggesting it is because they diagnose more women at an early stage.

‘Balance to strike’

Prof Montserrat Garcia-Closas, of the Institute of Cancer Research in London, said: “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.”

A decision on lowering the age of the breast cancer screening programme would have to be made by the UK National Screening Committee.

A Nice spokesman 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.”

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