A study conducted by researchers at the University of Cambridge and the Institute of Cancer Research has found significant gaps in the criteria used by general practitioners in England to identify women at elevated breast cancer risk. The analysis, published in the British Journal of Cancer, compared current National Institute for Health and Care Excellence (Nice) referral guidelines with an alternative risk assessment model called Boadicea, developed by Cambridge and funded by Cancer Research UK.
The research indicates that existing Nice criteria, which primarily rely on family history, fail to identify up to 95% of women under 50 who will develop breast cancer within 10 years. When compared with the Boadicea system, researchers identified eight times as many women in this age group who would be classified as higher-risk. A principal reason for this discrepancy is that approximately 73% of women under 50 who develop breast cancer within a decade have no family history of the disease, making them invisible to guidelines that emphasize hereditary factors.
The Boadicea model incorporates additional factors beyond family history, including reproductive history, lifestyle, and genetic information. Breast cancer remains the most common cancer worldwide, accounting for approximately one in four cancer cases and representing a leading cause of death among women under 50. Earlier identification of at-risk women could enable doctors to intervene with additional screening or preventive treatments.
Experts emphasized the need for guideline revisions, though stakeholders acknowledged potential challenges. Researchers noted the tension between the simplicity of current guidelines and their limited effectiveness, against the resource demands and costs of implementing more comprehensive risk assessment systems across the National Health Service. Breast Cancer Now, which supported the study, called for any changes to be accompanied by adequate investment in family history services to ensure equitable implementation.
Nice stated that while it welcomes the study’s findings and recognizes potential value in multifactorial risk models, current evidence does not justify immediate changes to existing guidelines. The organization indicated it remains open to reviewing additional evidence as more data on feasibility and clinical outcomes emerge.
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