A study led by the University of Cambridge and the Institute of Cancer Research has identified significant gaps in the criteria used by general practitioners in England to identify women at elevated risk of breast cancer. The findings, published in the British Journal of Cancer, reveal that existing National Institute for Health and Care Excellence (Nice) guidelines fail to refer the majority of women under 50 who subsequently develop the disease within a decade.
Researchers compared the current Nice referral criteria with a new risk assessment tool called Boadicea, which was developed by Cambridge and funded by Cancer Research UK. The analysis identified eight times as many at-risk women in the younger age group compared to those identified under existing guidelines. According to the study, the current Nice criteria miss up to 95% of women under 50 with higher-than-average breast cancer risk, and 95% of women who develop the disease within 10 years.
A primary factor contributing to 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 forms the cornerstone of Nice’s current referral framework. The Boadicea system examines additional variables including reproductive history, lifestyle factors, and genetic information to provide more comprehensive risk assessment.
Experts argue that earlier identification of high-risk women could enable timely intervention through additional screening or preventive treatments. However, officials acknowledge the tension between ease of implementation and resource constraints. Nice stated that while it welcomes the study findings and recognizes the potential of multifactorial risk models, the current evidence does not warrant changes to existing guidelines at this time. The organization indicated it remains committed to reviewing new evidence as additional data on feasibility and clinical outcomes become available.
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