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Women with a family history of breast cancer should take preventative drugs, says NICE

21 January 2013

By Dr Lux Fatimathas

Appeared in BioNews 689

Women at high risk of developing breast cancer should be offered preventative drugs, says an updated draft guideline from the National Institute for Health and Clinical Excellence (NICE).

'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', says chief executive of the charity Breakthrough Breast Cancer, Chris Askew.

In the UK, breast cancer affects approximately 50,000 women a year, with ten percent of cases being familial. Familial breast cancer refers to cases where there is a strong family history of the disease, suggesting a genetic predisposition. Some genetic mutations are known to significantly increase the risk of developing breast cancer, such as mutations in the BRCA1 and BRCA2 genes.

'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', says director of the Centre for Clinical Practice at NICE, Professor Mark Baker.

The guideline suggests women who are at high risk of familial breast cancer should be offered preventative treatment in the form of the drugs, tamoxifen or raloxifene, provided they do not have a history of blood clots or womb cancer. Different drug combinations are to be considered dependent on whether the women are pre- or post-menopausal. Based on evidence from recent studies, the drugs would be taken for a period of five years in order to decrease the likelihood of developing breast cancer. Tamoxifen and raloxifene are both hormone therapies currently used to treat breast cancer.

In the USA, the drugs have already been approved by the Food and Drug Administration for use in preventing breast cancer. However in the UK, they are not yet licensed for use in this context. They would therefore need to be prescribed 'off label' if there is 'good evidence to support that use', reports NICE.

Other suggestions by NICE include changes to the frequency of mammogram screening, which are currently offered every three years to women over the age of 50. For women who have not had breast cancer but are aged over 40 and at high risk, NICE suggests annual mammogram screening. For women who have had breast cancer and are at high risk of developing breast cancer again, annual MRI (magnetic resonance imaging) or mammogram testing was proposed, in addition to genetic testing for known mutations.

A spokeswoman from the Department of Health told the Guardian: 'This draft guidance will help healthcare professionals support the needs of their patients and we encourage organisations or individuals with an interest to give their feedback'.

The guidelines are still under consultation and are subject to change. The final version is expected to be published in June 2013.

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