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Rachel V Thomas

NHS Breast Cancer Screening Misses 95% Of High-Risk Young Women In UK: Why Personalized Care Could Be Key

NHS Breast Cancer Screening Misses 95% of High-Risk Young Women in UK: Why Personalized Care Could Be Key

The currently used <span><a href="https://www.healthandme.com/health/breast-cancer">breast cancer</a> screening</span> referral criteria at the NHS are missing up to 95% of women under 50 who are at higher risk of developing <span><a href="https://www.healthandme.com/health/breast-cancer">breast cancer</a></span> in the next decade, according to a new study.

Published in the British Journal of Cancer, the study found that a more comprehensive, <span>personalized risk assessment</span> could identify 8 times as many women at risk as the current NICE guidelines.

In England, women at higher risk of breast cancer are typically identified after being referred by their GP based on family history, following criteria set by the National Institute for Health and Care Excellence (NICE), under the NHS.

The researchers from the University of Cambridge and The Institute of Cancer Research, London, analyzed data from 1,258 women under the age of 50. 

They found that the criteria would refer only 1.4% of women for specialist assessment and identify just 4.4% of women who went on to develop breast cancer within the next 10 years.

<h2>Why Personalized Assessment Is Better?</h2>

The researchers then evaluated BOADICEA, a multifactorial risk model that combines:

<ul><li>Family history</li><li>Lifestyle factors</li><li>Reproductive history</li><li>Genetic information</li></ul>

Using this model, 26.5% of women were classified as having above-average risk and referred for further assessment. This approach identified 34.8% of women who developed breast cancer within the following 10 years—around eight times more than the current NICE criteria.

One major reason for the gap is that 73% of women under 50 who developed breast cancer had no family history of the disease, making them unlikely to qualify for referral under existing guidelines.

"We need to get better at identifying women at highest risk of breast cancer so that we can intervene early, when there are more options for treating, or even preventing, their disease," said Dr Juliet Usher-Smith from the Department of Public Health and Primary Care at the University of Cambridge.

A second study by the same research team found strong public support for proactive <span>breast cancer risk</span> assessments for women aged 30 to 49, instead of relying on women to seek GP referrals because of family history.

<ul><li>Proactive invitations for risk assessment</li><li>Comprehensive risk models such as BOADICEA</li><li>Genetic testing where appropriate</li><li>Assessing all women rather than only those with a family history</li></ul>

Dr Sowmiya Moorthie, Senior Strategic Evidence Manager at Cancer Research UK, said broader risk assessment could help more women receive personalized care. However, she noted that further research is needed to understand the impact on NHS staffing, equipment, and patient experience, while ensuring any new approach remains accessible and equitable.

She also emphasized that maintaining a healthy weight, limiting alcohol intake, and seeking medical advice for any unusual breast changes remain important ways to reduce risk and improve outcomes through early diagnosis.

Breast cancer is the most common cancer worldwide, with steady increases in incidence over the last few decades. It accounts for around one in four cases of cancer and 15 per cent of cancer deaths in women, and is one of the leading causes of death in women under 50.

Breast cancer is the most common cancer in the UK, with around 59,400 new cases diagnosed annually and roughly 11,200 deaths each year. About one in seven women in the UK develops the disease in their lifetime, though survival rates are high, with nearly 90% surviving for five years or more.

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The currently used breast cancer screening referral criteria at the NHS are missing up to 95% of women under 50 who are at higher risk of developing breast cancer in the next decade, according to a new study.Published in the British Journal of Cancer, the study found that a more comprehensive, personalized risk assessment could identify 8 times as many women at risk as the current NICE guidelines.Current Screening CriteriaIn England, women at higher risk of breast cancer are typically identified after being referred by their GP based on family history, following criteria set by the National Institute for Health and Care Excellence (NICE), under the NHS.The researchers from the University of Cambridge and The Institute of Cancer Research, London, analyzed data from 1,258 women under the age of 50. They found that the criteria would refer only 1.4% of women for specialist assessment and identify just 4.4% of women who went on to develop breast cancer within the next 10 years.Why Personalized Assessment Is Better?The researchers then evaluated BOADICEA, a multifactorial risk model that combines:Family historyLifestyle factorsReproductive historyGenetic informationUsing this model, 26.5% of women were classified as having above-average risk and referred for further assessment. This approach identified 34.8% of women who developed breast cancer within the following 10 years—around eight times more than the current NICE criteria.One major reason for the gap is that 73% of women under 50 who developed breast cancer had no family history of the disease, making them unlikely to qualify for referral under existing guidelines."We need to get better at identifying women at highest risk of breast cancer so that we can intervene early, when there are more options for treating, or even preventing, their disease," said Dr Juliet Usher-Smith from the Department of Public Health and Primary Care at the University of Cambridge.Proactive Screening MattersA second study by the same research team found strong public support for proactive breast cancer risk assessments for women aged 30 to 49, instead of relying on women to seek GP referrals because of family history.They found that women preferred:Proactive invitations for risk assessmentComprehensive risk models such as BOADICEAGenetic testing where appropriateAssessing all women rather than only those with a family historyDr Sowmiya Moorthie, Senior Strategic Evidence Manager at Cancer Research UK, said broader risk assessment could help more women receive personalized care. However, she noted that further research is needed to understand the impact on NHS staffing, equipment, and patient experience, while ensuring any new approach remains accessible and equitable.She also emphasized that maintaining a healthy weight, limiting alcohol intake, and seeking medical advice for any unusual breast changes remain important ways to reduce risk and improve outcomes through early diagnosis.Global Breast Cancer BurdenBreast cancer is the most common cancer worldwide, with steady increases in incidence over the last few decades. It accounts for around one in four cases of cancer and 15 per cent of cancer deaths in women, and is one of the leading causes of death in women under 50. Breast cancer is the most common cancer in the UK, with around 59,400 new cases diagnosed annually and roughly 11,200 deaths each year. About one in seven women in the UK develops the disease in their lifetime, though survival rates are high, with nearly 90% surviving for five years or more.

nhs breast cancer screening misses 95% of high-risk young women in uk: why personalized care could be key

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