Cutting cancer risk, no knife

The National Institute for Health and Clinical Excellence (NICE) has launched a consultation on an updated, draft version of their clinical guideline on familial breast cancer. The update includes provisional recommendations relating to genetic testing, screening and the use of preventive treatments, such as tamoxifen or raloxifene for high-risk patients.

The draft update also, for the first time, makes recommendations for people with a recent diagnosis of breast cancer who also have a family history of the disease.

Breast cancer is the most common cancer in the UK with around 50,000 women and 400 men diagnosed with the condition each year. The majority of cases are sporadic and occur by chance but people with a family history of cancer have a much higher chance of developing the disease than those who do not, and at a younger age.

The updated guideline, published in draft for consultation, includes a number of potential new recommendations on issues including: when to offer genetic testing; what surveillance strategies should and should not be offered; and the use of tamoxifen or raloxifene as treatments to prevent breast cancer as an alternative to performing mastectomies.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “The causes of cancer are complex and not fully known. However, we do know that having a family history of breast, ovarian or a related cancer can significantly increase the risk of developing breast cancer, including developing the cancer at a younger age. It is also more likely that people with family members affected by cancer who then develop breast cancer themselves could develop a separate tumour in the other breast following initial treatment. This is why it’s wise for any person with a family history of cancer to receive appropriate investigations and screening that would otherwise be unnecessary if a family history did not exist.

“This guideline was last updated in 2006. Since then there has been new evidence published and new advances made in a number of clinical areas. All of our guidelines are reviewed in line with regular practice to ensure they remain based on the most up-to-date evidence. New recommendations for this guideline – which are still in draft form – have been developed as a result and we now want to hear the views of registered stakeholders in order to aid the development of this guideline update.”

Chief executive of the charity Breakthrough Breast Cancer, Chris Askew, said: “This draft guideline represents a historic step for the prevention of breast cancer – it is the first time drugs have ever been recommended for reducing breast cancer risk in the UK.”

The draft update of the familial breast cancer clinical guideline is available to view on the NICE website (www.nice.org.uk).

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