NHS criteria used by GPs to refer women at risk of breast cancer for further testing, miss up to 95 per cent of patients who later develop the disease, concerning analysis suggests.
Breast cancer is one of the leading causes of death in women under 50 in the UK.
The criteria GPs use to refer women at risk of breast cancer for further testing misses up to 95 per cent of those who later develop the disease, a report has suggested Credit: Getty
In England, women at a higher risk of the disease are referred by their GP for further assessment and specialist care.
This referral is based on family history and criteria set by the National Institute for Health and Care Excellence (Nice).
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But, University of Cambridge researchers who analysed data from 1,258 women under 50, found that NICE criteria miss up to 95 per cent of women in this age group who have a higher-than-average risk of breast cancer.
Writing in the British Journal of Cancer, they also concluded that 95 per cent of women who go on to develop the disease within 10 years, were missed.
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Using a new risk assessment tool, known as Boadicea, experts identified eight times as many women in the age group who developed breast cancer.
The analysis suggested that using the Boadicea model for all women under 50 would lead to almost 27 per cent of women being classed as at an above-population level risk and referred for further assessment.
In comparison, the researchers found the current NICE criteria would result in 1.4 per cent women being referred for tests, including 4.4 per cent who go on to develop breast cancer.
Dr Juliet Usher-Smith from the Department of Public Health and Primary Care, University of Cambridge, the study’s senior author, said: “It’s time to look again at these criteria in the light of our findings.
“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.”
Dr Simon Vincent, chief scientific officer at Breast Cancer Now, which supported the study, said: “Finding new ways to identify women at increased risk could help to prevent some breast cancers or detect them earlier, when treatment is more likely to be successful.
“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, Dr Vincent said it is “equally important” that any changes are backed by investment so they can be implemented fairly across the NHS.
Dr Sowmiya Moorthie, senior strategic evidence manager at Cancer Research UK, which funded the study, said: “Exploring different ways to identify women with a higher risk of breast cancer could help people receive more personalised care.
“The current UK approach, which relies on women under 50 self-presenting, misses many women with a higher risk of breast cancer who could benefit from targeted support and guidance on how to manage their risk.
What are the signs of breast cancer?
BREAST cancer is the most common type of cancer in the UK.
The majority of women who get it are over 50, but younger women and, in rare cases, men can also get breast cancer.
Around 2,500 people under the age of 40 are diagnosed with breast cancer every year, according to CoppaFeel!
The disease is also is one of the leading causes of death in women under 50.
If it’s treated early enough, breast cancer can be prevented from spreading to other parts of the body.
Breast cancer can have a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps aren’t cancerous, but it’s always best to have them checked by your doctor. You should also speak to your GP if you notice any of the following:
A change in the size or shape of one or both breasts
Discharge from either of your nipples (which may be streaked with blood)
A lump or swelling in either of your armpits
Dimpling on the skin of your breasts
A rash on or around your nipple
A change in the appearance of your nipple, such as becoming sunken into your breast
To check your breasts or chest:
Look at your breasts or chest in a mirror to look for any changes. Start with your arms by your sides and then raise them.
Feel around each breast or side of your chest in a circular motion all the way up to your collarbone and under each armpit. Use a mix of light and firmer pressure. Do not press so hard it hurts.
Feel around and over each nipple.
You may find it easier to feel your breasts or chest in the shower or lying down.
Source: NHS, Coppafeel!
“Further research is needed, however, to understand the impact of adopting a different approach, including on staffing and equipment.
“Any changes must be accessible and equitable, taking into consideration the anxiety that extra referrals might cause for women.”
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.”
Symptoms of breast cancer may include a lump or swelling in the breast, chest or armpit, a change in the skin of your breast, such as dimpling or redness and a change in the size or shape of one or both breasts.
It’s important to check your breasts regularly so you know what’s normal for you.
This makes it easier to notice any changes in the size, look or feel of your breasts.
There are around 59,400 new breast cancer cases in the UK every year – that’s around 160 every day, according to Cancer Research UK.
And sadly around 11,200 people die from breast cancer every year in the UK.
