Women at risk of breast cancer due to their family history now have more options than ever before to help prevent the disease, following updated guidance from NICE.

Breast cancer is the most common form of cancer in the UK, and of all those who develop the condition, around one in five has a family history of the disease.

A family history of breast cancer is often caused by faults with the BRCA1 or BRCA2 genes, which have been passed on from parent to child.

Cancer Research UK estimates that people who carry the BRCA gene have between a 60-90 per cent chance of developing breast cancer.

Currently, if a person is considered to have a high risk of breast cancer through factors such as a family history, they are eligible for annual screening to detect any tumour early on.

Alternatively they can choose surgery to remove their breasts to prevent developing disease.

This is a major and traumatic intervention for all involved, and was recently highlighted by the case of Angelina Jolie who chose to go public with her decision to opt for a double mastectomy.

In updated guidance from NICE, women with a family history of breast cancer are now eligible for drug treatments as a measure to help prevent the disease.
NICE recommends that either tamoxifen or raloxifene should be offered for 5 years to postmenopausal women with a uterus and at high risk of breast cancer, unless they have a past history or may be at increased risk of thromboembolic disease or endometrial cancer.

NICE says that that tamoxifen is effective in reducing breast cancer incidence when used for chemoprevention in both pre and post-menopausal women who do not have a diagnosis of breast cancer. Evidence also shows that for post-menopausal women with no diagnosis of breast cancer specifically, tamoxifen and raloxifene have similar effectiveness when used as preventative treatments.

Estimates suggest that offering these treatments could help prevent breast cancer around three per cent of all women aged 35 years and older - affecting around 488,000 women.

While neither drug is currently licensed as a preventative treatment for breast cancer, they are currently approved for use in the US. Evidence shows that both treatments are equally effective in preventing breast cancer, and can reduce a person's risk by between 30 and 40 per cent.

NICE has also halved the threshold for offering genetic testing to a relative who has breast and/or ovarian cancer.

In previous guidance, genetic testing could be offered if it has been calculated that the family member has 20 per cent or more chance of carrying either a BRCA1 or BRCA2 gene mutation.

In the updated guidelines, this threshold has been halved to where there is a 10 per cent chance of developing either of the gene mutations, consequently increasing to genetic testing for a far greater number of women.

Doctors should calculate a person's risk of getting breast cancer by assessing a person's family history and using calculation methods such as BOADICEA or the Manchester scoring system.

Additionally, NICE says that the NHS should offer MRI screening every year to all women aged 30-49 years who have, or who have had, breast cancer and who remain at high risk of the disease. This includes those with a BRCA1 or BRCA1 mutation.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Our updated guideline now gives women more options in how they manage their risk of breast cancer; those with a ‘moderate' or ‘high' risk of developing breast cancer because of their family history but who have not had the disease themselves can now be offered tamoxifen or raloxifene for five years to prevent it.

He added: "Although neither drug is licensed as a preventative treatment in the UK, clinical evidence shows they are an effective option for many women and could be preferable to surgery."

Baroness Delyth Morgan, Chief Executiver of Breast Cancer Campaign, said: "This is a truly historic moment in the treatment of women at increased breast cancer, as we are witnessing a fundamental change of clinical practice driven by medical research.

"We strongly welcome NICE's decision to recommend chemoprevention treatments and a broadening of access to genetic testing and surveillance. Having varied options available to women at an increased risk enables more effective prevention, detection and treatment of the disease."

Professor Gareth Evans, a Consultant in Clinical Genetics at St Mary's Hospital and member of the Guideline Development Group, said: "The whole guideline is a major move forward in that more women than ever before now face the possibility of doing something tangible to reduce their risk of breast cancer. That can only be a good thing."

Source: NICE