NHS criteria for screening women under 50 for breast cancer are too narrow and may be missing up to 95% of those at higher risk, according to researchers. The current guidelines, set by the National Institute of Health and Care Excellence (Nice), focus only on inherited genes, overlooking other factors such as lifestyle.
A study published in the British Journal of Cancer used a new risk assessment tool, Boadicea, which combines factors including family history, lifestyle, reproductive history, and genetic information. This tool identified eight times as many women under 50 who developed breast cancer compared to the current Nice criteria.
Researchers estimate that if all women under 50 were assessed with this tool, about a quarter (26.5%) would be categorised as at above-average risk and referred for further assessment. This would include a third of women under 50 (34.8%) who develop breast cancer within 10 years. In contrast, current Nice criteria would refer 1.4% of women under 50, including just 4.4% of those who develop breast cancer.
A primary reason for this disparity is that 73% of women under 50 who develop breast cancer within a decade have no family history of the disease, which is a key criterion in the Nice guidelines. Nice has welcomed the findings and acknowledged the potential of multifactorial risk assessment tools, but stated that current evidence does not warrant a change to its breast cancer guidelines.
Women are encouraged to be aware of what is normal for their breasts and to consult a doctor if they notice any changes.