A study conducted by the University of Cambridge and the Institute of Cancer Research, London, found that guidelines used by general practitioners in England to identify women at risk of breast cancer are missing the vast majority of patients under 50 who will develop the disease within a decade. The research, published in the British Journal of Cancer, compared existing criteria established by the National Institute for Health and Care Excellence (Nice) against a new risk assessment system called Boadicea, developed by Cambridge and funded by Cancer Research UK.
According to the analysis, the current Nice criteria miss up to 95% of women aged under 50 with higher-than-average breast cancer risk and 95% of women in that age group who will develop the disease within 10 years. The study identified eight times as many women in this demographic who would eventually develop breast cancer when using the new assessment tool. A significant factor in this disparity is that approximately 73% of women under 50 who develop breast cancer within 10 years have no family history of the disease, which remains a key criterion in the Nice guidelines.
The Boadicea system examines additional factors beyond family history, including reproductive history, lifestyle, and genetics. Researchers argued that earlier identification of women at highest risk could enable medical professionals to intervene more effectively through screening or preventive treatment options. However, experts acknowledged potential challenges in implementation, noting that while the current Nice criteria are simpler to administer, a comprehensive risk assessment including genetic testing could place significant strain on healthcare resources.
Breast cancer is the most common cancer globally and accounts for approximately one in four cancer cases. It is also among the leading causes of death in women under 50. A Nice spokesperson responded to the findings by stating that while the organization recognizes the potential of multifactorial risk models, the current evidence does not justify immediate changes to existing guidelines. Nice indicated it remains open to reviewing new evidence and considering updates as additional data on feasibility and clinical outcomes become available.
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