Is breast cancer care about to change?

Posted: 17/01/2013

The National Institute of Health and Clinical Excellence (NICE) has launched a consultation on whether women in England and Wales with a strong likelihood of developing breast cancer could be offered medication on the NHS to try to prevent the disease.

Professor Mark Baker, director of the centre for clinical practice at NICE, explains: "Having a family history of breast, ovarian or a related cancer can significantly increase the risk of developing breast cancer, including developing the cancer at a younger age.”

Those women who carry the BRCA1 or BRCA2 mutation face real concerns about their future; in the case of those with the BRCA1 mutation they have a 65% chance of developing breast cancer by the time they reach the age of 70.

Until now, these women have only had two options – either to hope that they would never develop the disease, or to undergo a double mastectomy. These NICE draft guidelines now provide another option – preventative drugs.

International trials show that drugs such as Raloxifene and Tamoxifen reduce 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. Benefit has been shown for those at moderate risk of developing breast cancer as well as high risk.

However, the benefit of taking these drugs will have to be balanced against the associated risks. Both Tamoxifen and Raloxifene, which are used after menopause, are licensed in the US for breast cancer prevention, but are not widely taken up, partly because of concerns about possible side effects.

According to MacMillan Cancer Support, possible side effects of Tamoxifen include hot flushes, nausea, indigestion, weight gain and leg cramps and less common side effects include depression, tiredness, headaches, blood clots, vision problems, voice changes and in rare cases, womb cancer.

Currently, neither Tamoxifen nor Raloxifene are licensed for breast cancer prevention in the UK. However, breast cancer specialist Professor Michael Baum comments: "I don’t think women or doctors will be deterred from using them by the lack of a licence.”

Breast cancer charities have hailed the new draft guidelines as an historic step because this is the first time drugs have ever been recommended for reducing breast cancer in the UK. The final NICE guidance is expected to be released this summer.

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