Most at-risk under-50s missed by NHS breast cancer rules

New research has revealed that current breast cancer checks are “missing” most women under 50 who are at risk of developing the life-threatening disease.

Despite breast cancer being a leading cause of death in women under 50, it’s not something that is routinely screened for until after a woman turns 50 – meaning the current National Institute for Health and Care Excellence (NICE) guidelines are missing 95% of young women who are at risk.

A study conducted by a team from Cambridge University and the Institute of Cancer Research found that current NHS guidelines set by NICE are too narrow, as they focus solely on inherited genes for screening women under 50.

This means that lifestyle factors which can sometimes contribute to breast cancer – including drinking too much alcohol or being obese – are being disregarded. 

While all women over the age of 50 are offered routine mammogram appointments by the NHS to screen for breast cancer, younger women are only screened should they have specific genes that can predispose them to breast cancer.

Most cases of breast cancer (96%) are in women over 40, with 25% affecting women over 75, which is why the NHS currently offers routine mammograms to women over 50 (although there are some exceptions to this rule). But, given that breast cancer is one of the leading causes of death in women under 50 in the UK, there have been calls from campaigners to lower the age for mammograms, with this study highlighting a clear need, at the very least, to widen screening criteria.

Dr Juliet Usher-Smith of the University of 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.

“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.”

This study, by a team from Cambridge University and the Institute of Cancer Research, looks at how to predict breast cancer risk in younger women.

They used a risk calculator called Boadicea that combines factors such as family history, lifestyle, reproductive history and genetic information to give a risk score.

If all women under 50 were to have this done, they estimate about a quarter (26.5%) would be categorised as at above-average risk and referred for further assessment.

This would include a third of women under 50 (34.8%) who develop breast cancer within 10 years.

By comparison, the current Nice criteria would result in 1.4% of women under 50 being referred for further assessment, which would include just 4.4% of those women who develop breast cancer.

A main reason for the disparity, the researchers say, is because three-quarters of women (73%) under 50 who develop breast cancer within a decade have no family history of breast cancer – the key criterion in the Nice guidelines.

Breast cancer is a leading cause of death in women under 50 in the UK.

Most cases – 96% – are in women over 40, while 25% are in women over 75.

Men can get breast cancer too, with about 420 new cases every year in the UK.