|English: Most common cancers in the United States 2008. See Epidemiology of cancer (Photo credit: Wikipedia)|
Each year almost 50,000 women are being diagnosed with breast cancer. Out of which, around 2,400 have inherited defective 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 for developing breast cancer, accounting for at least 4 per cent of all women.
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.Having a family history of breast or ovarian cancer can significantly increase the risk of developing breast cancer and at a younger age, although most women with a relative with breast cancer are not at a substantially increased risk themselves.
National Institute of Health and Clinical Excellence (NICE) says under 1% of women over 30 fall into the high-risk category. NICE says not enough is being done to help healthy but high-risk women, who include women with a sister and a mother or aunt diagnosed with breast cancer before the age of 50.
Tamoxifen, an estrogen receptor (ER) inhibitor, has been used to treat the illness for more than 30 years, saving the lives of hundreds of thousands at a low cost, although newer drugs are proving even more effective.
Based on research findings, experts estimate that for every 1,000 women given tamoxifen, there would be 20 fewer breast cancers.
New draft guidelines suggest the drugs tamoxifen or raloxifene (A drug for osteoporosis) could offer as much as 20 years of protection for those considered at high risk of cancer.
The new draft guidelines for England and Wales, which would update recommendations made by NICE in 2006, apply to these women and focus on areas of care where new evidence has been published, which includes using tamoxifen as a preventative treatment.
The National Institute of Health and Clinical Excellence has launched a consultation on whether tamoxifen could be given for up to five years.
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.Women in England and Wales with a strong family history of breast cancer could be offered medication on the NHS to try to prevent the disease.
Both drugs are already used in other countries to prevent breast cancer, for example in the United States, where they have been approved for that purpose by the federal Food and Drug Administration.
Nice is recommending that pre-menopausal women at high risk should be offered tamoxifen unless they have a history of thromboembolic disease or endometrial cancer, and that post-menopausal women with the same medical history who are at high risk should be offered either drug, in both cases for five years.
In addition, doctors should consider prescribing tamoxifen to pre-menopausal women at moderate risk of developing breast cancer within the next 10 years, and either drug to post-menopausal women with the same risk, again in both cases for five years, Nice's guideline says.The aim is to slash the odds of developing breast cancer in the first place – just as statins are given to patients to reduce cholesterol.
If approved later this year, the draft guidelines would be the first of their kind in the UK.