NICE consults on new recommendations as it updates its guidelines on familial breast cancer
The National Institute for Health and Care Excellence (NICE) is currently in the process of updating its clinical guideline on familial breast cancer[i]. Today (15 January), NICE has begun a consultation on a draft version of the guideline with new, provisional recommendations relating to genetic testing[ii], screening and the use of preventive treatments. The draft update also, for the first time, makes recommendations for people with a recent diagnosis of breast cancer who also have a family history of the disease.
Breast cancer is the most common cancer in the UK with around 50,000 women and 400 men diagnosed with the condition each year[iii]. The majority of cases are sporadic and occur by chance but people with a family history of cancer have a much higher chance of developing the disease than those who do not, and at a younger age.
The updated guideline, published today (15 January) in draft form for consultation, includes a number of potential new recommendations on issues including; when to offer genetic testing; what surveillance strategies should and should not be offered; and the use of tamoxifen or raloxifene[iiii] as treatments to prevent breast cancer.
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “The causes of cancer are complex and not fully known. However, we do know that 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. It is also more likely that people with family members affected by cancer who then develop breast cancer themselves could develop a separate tumour in the other breast following initial treatment. This is why it's wise for any person with a family history of cancer to receive appropriate investigations and screening that would otherwise be unnecessary if a family history did not exist.
“This guideline was last updated in 2006. Since then there has been new evidence published and new advances made in a number of clinical areas. All of our guidelines are reviewed in line with regular practice to ensure they remain based on the most up-to-date evidence. New recommendations for this guideline - which are still in draft form - have been developed as a result and we now want to hear the views of registered stakeholders in order to aid the development of this guideline update.”
The draft update of the familial breast cancer clinical guideline is available to view on the NICE website. As with all clinical guideline consultations, only registered stakeholders such as professional and government organisations, patient and carer groups and companies can comment formally on consultations. However, organisations can register as a stakeholder at any time during the development of a guideline. Registered stakeholders have until Monday 25 February 2013 to submit their comments.
Notes to Editors
- The draft update of the NICE clinical guideline on familial breast cancer will be available from the NICE website from Tuesday 15 January 2013. Please contact the press office for an embargoed copy of the draft guideline.
- This guideline focuses on the management of people with a family history of breast, ovarian or another related cancer and who are subsequently at increased risk of developing breast cancer. The 2013 update of this guideline, which is currently in development, also includes people who have been diagnosed with breast cancer and who have a family history of the disease.
- The draft guideline issued for consultation today (15 January 2013) is an update of the Institute's familial breast cancer guideline which was originally published in 2004 and updated in 2006. This 2013 update focuses on specific areas of care where new evidence has been published since 2006.
A family history of breast cancer is a known risk factor for breast cancer. The stronger the family link is, the more a person's likelihood of developing the disease is increased. The risk of developing breast cancer can depend on;
- the nature of the family history
- the number of relatives who have developed breast, ovarian or a related cancer
- the age at which relatives developed breast cancer
- the age of the person in question
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
- social care - the Health and Social Care Act (2012) sets out a new responsibility for NICE to develop guidance and quality standards for social care. To reflect this new role, from 1 April 2013 NICE will be called the National Institute for Health and Care Excellence (NICE) and it will become a Non-Departmental Public Body.
3. NICE produces standards for patient care:
- quality standards - these describe high-priority areas for quality improvement in a defined care or service area
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
- CCG Outcomes Indicator Set (formerly known as COF) - NICE develops the potential clinical health improvement indicators to ensure quality of care for patients and communities served by the clinical commissioning groups (CCGs)
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
[i] Familial breast cancer is also known as hereditary breast cancer and is associated with having a family history of breast, ovarian or a related cancer. Familial breast cancer typically occurs in people with an unusually high number of family members affected by breast, ovarian or a related cancer. The risk of developing breast cancer depends on the nature of the family history; number of relatives who have developed breast, ovarian or a related cancer; age at which relatives developed breast cancer; age of the person. Often (but not always) a family history of breast cancer can be caused by a genetic mutation (a faulty gene) and this can be inherited by children from their parents.
[ii] The aim of genetic testing is to confirm if a person has any genetic mutations that raise the risk of cancer. There are two key genes in a person's body - BRCA1 and BRCA2 - which, if faulty, greatly increase the risk of developing breast cancer. Genetic mutations can be passed down through the generations and women with a faulty BRCA gene also have an increased risk of developing ovarian, pancreatic and prostate cancer.
[iii] Data were provided to the charity, Cancer Research UK by the Office for National Statistics, the Northern Ireland Cancer Registry, Welsh Cancer Intelligence and Surveillance Unit and ISD Scotland on request in September 2012. Full details can be found on the Cancer Research UK website.
[iiii] At the time of publication, neither tamoxifen nor raloxifene have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Good practice in prescribing medicines - guidance for doctors for further information.
This page was last updated: 15 January 2013