The National Institute for Health and Care Excellence (NICE) criteria used to refer women under 50 for further breast cancer risk assessment may miss up to 95% of those who will develop the disease within the next decade, according to research published on Aug. 3 by the University of Cambridge and The Institute of Cancer Research, London.
Researchers compared the effectiveness of NICE guidelines with BOADICEA, a comprehensive risk assessment tool developed at Cambridge. They found that BOADICEA identified eight times as many women in this age group who later developed breast cancer than did NICE criteria. Breast cancer remains the most common cancer worldwide and is a leading cause of death among women under 50. Early identification allows for additional screening or preventive treatment.
The study analyzed data from 1,258 women under age 50 enrolled in the Breast Cancer Now Generations Study between 2004 and 2011. It found that using BOADICEA for all women in this group would result in about one-quarter being classified as above-average risk and referred for further evaluation—capturing more than one-third of those who go on to develop breast cancer within ten years. In contrast, current NICE guidelines would refer only about one percent, identifying less than five percent of future cases.
Researchers said a key reason is that nearly three-quarters of younger women who develop breast cancer have no family history—the main factor considered by NICE's current approach. Dr. Juliet Usher-Smith from 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." She added, "The current NICE criteria used in general practice are missing up to 95% 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."
While changing referral practices could increase resource demands due to more assessments—including genetic testing—Professor Montserrat Garcia-Closas from The Institute of Cancer Research 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... Ultimately, it will be a trade-off between practical... implications... and potential benefits and harms associated with accurate and inaccurate classification." A second study showed public support for proactive invitations using comprehensive tools like BOADICEA rather than relying solely on family history.
Dr. Simon Vincent from Breast Cancer Now said, "Finding new ways to identify women at increased risk could help prevent some breast cancers or detect them earlier... These findings highlight the limitations of NICE's current referral criteria... However, it's equally important that any changes come with needed investment in family history services." Dr. Sowmiya Moorthie from Cancer Research UK added, "Exploring different ways to identify women with higher risk could help people receive more personalised care... Further research is needed... Any changes must be accessible and equitable."
