Update information

Update information

November 2019: A link to patient decision aids was added. Recommendation 1.6.5 was updated to add a cross-reference to recommendation 1.6.18 to clarify the topics that should be discussed with a person before making a mammographic surveillance decision.

March 2017: We updated recommendations in section 1.7 on chemoprevention for women with no personal history of breast cancer.

June 2013: We updated and included new recommendations on genetic testing thresholds, surveillance and risk reduction and treatment strategies for people without breast cancer who are at increased risk because of a family history of breast, ovarian or a related cancer. We included new recommendations on genetic testing thresholds, subsequent surveillance and risk reduction and treatment strategies for people with a diagnosis of breast cancer and a family history of breast, ovarian or a related cancer.

July 2006: We updated recommendations in section 1.6 on surveillance and strategies for early detection of breast cancer.

Recommendations are marked as [2017], [2013, amended 2017], [2013], [2006, amended 2013],[2004, amended 2013] or [2004].

[2017] indicates that the evidence was reviewed and the recommendation added or updated in 2017.

[2013, amended 2017] indicates that the evidence was reviewed in 2013, but changes were made to the recommendation wording in 2017 that changed the meaning.

[2013, amended 2019] indicates that the evidence was reviewed in 2013, but changes were made to the recommendation wording in 2017 that changed the meaning.

[2013] indicates that the evidence was reviewed and the recommendation added or updated in 2013.

[2006, amended 2013] indicates that the evidence was reviewed in 2006, but changes were made to the recommendation wording in 2013 that changed the meaning.

[2004, amended 2013] indicates that the evidence was reviewed in 2004, but changes were made to the recommendation wording in 2013 that changed the meaning.

[2004] indicates that the evidence was reviewed in 2004.

Recommendations that have been amended in 2017

Recommendation in 2013 guideline

Recommendation in current guideline

Reason for change

Healthcare professionals within a specialist genetic clinic should discuss and give written information on the absolute risks and benefits of all options for chemoprevention to women at high risk or moderate risk of breast cancer. Discussion and information should include the side effects of drugs, the extent of risk reduction, and the risks and benefits of alternative approaches, such risk-reducing surgery and surveillance. (1.7.20)

Healthcare professionals within secondary care or specialist genetic clinics should discuss the absolute benefits and risks of options for chemoprevention with women at high or moderate risk of breast cancer. Discussion, using a decision aid, should include the following to promote shared decision-making and informed preferences:

• the reduced risk of invasive breast cancer

• the lack of effect on mortality

• the side effects of the different options

• alternative approaches, such as surveillance alone and, for women at high risk, risk-reducing surgery.

Women should also be given information in an accessible format. (1.7.20)

Recommendation amended so that discussion includes the lack of effect on mortality and to clarify that risk-reducing surgery is an option only for some women at high risk. Use of a decision aid is also recommended to promote shared decision-making and informed preferences.

Do not offer tamoxifen or raloxifene to women who were at high risk of breast cancer but have had a bilateral mastectomy. (1.7.24)

Do not offer chemoprevention to women who were at high risk of breast cancer but have had a bilateral risk-reducing mastectomy. (1.7.24)

Recommendation amended to cover all types of chemoprevention and to clarify that mastectomy is risk reducing.

Do not continue treatment with tamoxifen or raloxifene beyond 5 years for chemoprevention in women with no personal history of breast cancer. (1.7.28)

Do not continue chemoprevention beyond 5 years in women with no personal history of breast cancer. (1.7.28)

Recommendation amended to cover all types of chemoprevention.

ISBN: 978-1-4731-0160-9

  • National Institute for Health and Care Excellence (NICE)