Tuesday, 15 January 2013

Breast Cancer prevention - age, history, genetics

The National Institute for Health and Clinical Excellence (NICE) have issued a consultation on the updated draft of its guidance on familial breast cancer due for publication in June 2013.

Widely reported in the news today is the proposed recommendation for tamoxifen or raloxifine at high risk of breast cancer. The news, as far as I can see doesn't highlight that this recommendation is for post-menopausal women. The BBC (Breast cancer drug tamoxifen recommended for 'high risk' women) seem to simplify the whole thing by only talking about tamoxifen and not mentioning the age issue except to say "Most cases occur by chance and with increasing age."

The full draft guidance says:
"Offer tamoxifen or raloxifene for 5 years to post-menopausal women at high risk of breast cancer unless they have a past history of thromboembolic disease or endometrial cancer."
The debate about genetic testing is discussed in the evidence review. There are three genes known to cause susceptibility BRCA1 BRCA2 and TP53 but they cause a minority of cases (5% or so). NICE favour family history over widespread genetic testing but I just wonder what the future will bring? If better genetic risks are identified then the complex computer algorithms and detailed family history checking to quantify risk might give away to more objective test.

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