Women under 50 at risk of breast cancer are not being referred, study warns

A major UK study has found that current NHS referral criteria may be failing to identify the vast majority of women under 50 who are at increased risk of developing breast cancer.

Researchers from the University of Cambridge and the Institute of Cancer Research found that the current National Institute for Health and Care Excellence (NICE) family history criteria identified only a small proportion of younger women who later developed breast cancer. The findings have been published in the British Journal of Cancer.

The researchers analysed data from 1,258 women aged under 50 who took part in the Breast Cancer Now Generations Study between 2004 and 2011. They found that the existing NICE referral criteria identified just 1.4% of women for specialist risk assessment, despite many more going on to develop breast cancer within the following decade. Overall, the study suggests the current approach fails to identify up to 95% of younger women who later develop the disease.

The team also evaluated the BOADICEA breast cancer risk prediction model, which considers a wider range of factors including genetic information, reproductive history and lifestyle. Using this approach, around 27% of women were identified as being at higher risk—around eight times more than under the current referral system.

Researchers say a more personalised approach to risk assessment could allow women at higher risk to access enhanced surveillance, preventative medication or other interventions at an earlier stage, potentially improving outcomes. However, they acknowledge that implementing broader risk assessments would require additional NHS resources and further evaluation.

In response to the findings, NICE said it welcomes new evidence but that current data are not yet sufficient to justify changing its referral recommendations. The organisation noted that its family history guidance is already under review and that emerging evidence will continue to be considered as part of that process.

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