Thousands of healthy women could be offered powerful breast cancer drugs to cut their chances of contracting the disease.
New guidelines suggest the drugs tamoxifen or raloxifene could offer as much as 20 years of protection for those considered at high risk of cancer.The aim is to slash the odds of developing breast cancer in the first place – just as statins are given to patients to stave off heart disease. Even women judged to be at ‘moderate’ risk of the disease in the next ten years, due to genetic or family history, could be given daily medication. Charities hailed the new guidance as an ‘historic step’ in the treatment of breast cancer.Tamoxifen has been used to treat the illness for more than 30 years, saving the lives of hundreds of thousands at a cost of just a few pence a day, although newer drugs are proving even more effective.
International trials show it reduces the risk of the most common kind of breast cancer by one third after five years, with the preventative effect lasting up to 20 years.The guidelines are released today by the National Institute for Health and Clinical Excellence, the watchdog responsible for advising the NHS on good practice.Women would take the drugs for five years either before or after the menopause. Currently in the UK, high-risk women can be offered annual MRI scans from the age of 40 and may decide to have preventative surgery, including the removal of their breasts.The guidance says more women at higher than average risk should be offered surveillance at a younger age to detect the disease earlier.
The risk of breast cancer in the general population is one in eight – but this rises to one in three for women at high risk and one in four for those at moderate risk.Almost 50,000 women a year are diagnosed with breast cancer. Of these, around 2,400 have inherited faults in known breast cancer genes while a further 5,000-7,000 are affected by genes not yet identified.Women with faulty genes such as BRCA1, BRCA2 and TP53 are among those at high risk, accounting for at least 4 per cent of all women.
The Nice proposals could also lead to more genetic testing. Women with some genetic mutations could be offered annual MRI scans from the age of 20 to 49.Those at moderate risk could be given annual X-ray scans from 40, while others could receive annual checks after the age 50 instead of three-yearly checks with the routine NHS screening programme.But the most controversial plan is for drugs to be prescribed as preventative therapy despite not being licensed for the purpose.
Both tamoxifen and the osteoporosis drug raloxifene, which is used after the menopause, are licensed in the U.S. for breast cancer prevention but are not widely taken up, partly because of concerns about side effects. Nice says the drugs are being recommended because they have ‘good evidence’ behind them.Breast cancer specialist Professor Michael Baum said the drugs were a ‘reasonable option’ for women at high risk because of evidence that they cut the death rate. He said ‘I don’t think women or doctors will be deterred from using them by the lack of a licence.
‘Nice’s support for preventive drugs could encourage clinicians, it will give them more confidence when talking to women at high risk about their options.’Chris Askew, of Breakthrough Breast Cancer, said the new guidance was ‘a historic step for the prevention of breast cancer’. He added: ‘It is the first time drugs have ever been recommended for reducing breast cancer risk in the UK.This is exciting as, even though most women do not have a significant family history of the disease, it’s crucial that those who do have an array of options to help control their risk.’ – DailyMail