NICE publishes new guidance for women at high risk of breast cancer

Almost half a million healthy women at high risk of breast cancer can now be offered drugs that can cut their chances of developing the disease, according to new doctors’ guidance released today. 

The decision means that, in addition to regular screening or risk-reducing surgery (mastectomy), high-risk women now have an third option – treatment with either tamoxifen or raloxifene.

The new guidelines, published by the National Institute for Health and Care Excellence (NICE), also recommend that more men and women can be offered tests for inherited genetic mutations that put them at high risk of the disease.

People who doctors calculate have a 10 per cent risk of carrying an inherited gene should now be offered testing, half the risk for which it was previously offered.

While not mandatory, NICE clinical guidelines are regarded as best practice and the NHS is encouraged to follow the recommendations as set out in the guidance.

Professor Peter Johnson, Cancer Research UK’s chief clinician, said the new recommendations were “a vital step forward” in improving care for people who face an increased risk of breast cancer because of their family history.

“Identifying those women who have inherited a faulty gene is important as they need different care from those who haven’t,” he said.

More than 49,500 women and around 400 men are diagnosed with breast cancer in the UK every year, of whom around one in five will have a cancer that’s linked to their family history.

Clinical research, including trials funded by Cancer Research UK, has shown that post-menopausal high-risk women who take tamoxifen for five years are half as likely to develop invasive breast cancer than women at normal risk.

Raloxifene is almost as effective, with a reduction in risk of a third for at-risk women who take the drug for five years. 

However, it carries a lower risk of complications in post-menopausal women, such as deep-vein thrombosis or a very small chance of uterine cancer.

Professor Gareth Evans, a consultant in clinical genetics at St Mary’s Hospital in Manchester who helped to develop the guidelines, said they were a “major move forward in that more women than ever before now face the possibility of doing something tangible to reduce their risk of breast cancer.”

The guidelines also recommend that the NHS should offer testing to healthy people if it is likely they have a genetic mutation in their family and have no living relative with cancer who could be tested instead.

And women who have previously had breast or ovarian cancer should be offered regular MRI scans to check for secondary cancers.

The updated guideline on familial breast cancer is published on the NICE website.