Study suggests current breast cancer referral criteria miss 95% of at-risk women under 50
Experts advocate for updated criteria based on new findings
New research indicates that the criteria used by GPs to refer women under 50 for breast cancer assessments may miss up to 95% of those who will develop the disease within a decade.
The analysis, conducted by researchers from the University of Cambridge and published in the British Journal of Cancer, examined data from 1,258 women under 50 who participated in the Breast Cancer Now Generations Study between 2004 and 2011. It shows that the existing criteria, set by the National Institute for Health and Care Excellence (Nice), fail to identify a significant proportion of women at elevated risk.
The study highlights a new risk assessment tool called Boadicea, which evaluates family history, reproductive history, lifestyle, and genetics. By applying this model, researchers identified eight times more women under 50 who developed breast cancer compared to current criteria.
The Boadicea model suggests that 26.5% of women under 50 would be classified as above-population level risk and referred for further assessment, including nearly 35% of those who develop breast cancer within a decade. By comparison, the Nice criteria refer just 1.4% of women for tests, including 4.4% who develop breast cancer.
Dr Juliet Usher-Smith from the University of Cambridge called for a reassessment of the criteria in light of these findings. Dr Simon Vincent of Breast Cancer Now emphasized the importance of considering this research in Nice’s ongoing review of family history guidelines to prevent breast cancers and detect them earlier.
However, implementing changes would require investment to ensure fair access across the NHS, Dr Vincent added. Professor Montserrat Garcia-Closas from the Institute of Cancer Research noted the balance needed between resource demands and benefits of comprehensive risk assessments, including genetic testing.
Dr Sowmiya Moorthie from Cancer Research UK pointed out that a different approach could offer more personalised care but require further research to assess its impact on resources and equity.
A Nice spokesperson acknowledged the potential of multifactorial risk models but stated that current evidence does not yet warrant an update to their familial breast cancer guidelines. Nice remains committed to considering new evidence as it becomes available.