24 January 2018

NICE consults on updated recommendations for the treatment and care of people with early breast cancer

NICE’s draft updated guideline on early and locally advanced breast cancer calls for extended hormonal therapy for some women after they’ve taken tamoxifen in order to reduce the risk of their breast cancer coming back.

  The new recommendation is for women who have been through the menopause who have a type of breast cancer called ER-positive invasive breast cancer and who have been taking tamoxifen for 2 to 5 years. It reflects research showing that switching to an aromatase inhibitor after taking tamoxifen for 5 years improved disease-free survival compared with women who had only received tamoxifen for 5 years.

Because there is an increased risk of problems, such as endometrial cancer and osteoporosis, with taking hormonal therapy for a long time, the committee agreed that healthcare professionals should discuss the potential benefits and risks with women to help them make an informed choice about their treatment.

The draft guideline also recommends that bone drugs called bisphosphonates should be offered alongside chemotherapy to women who have been through the menopause who have invasive breast cancer that has spread to nearby lymph nodes, and to other people with a high risk of their breast cancer returning. This is because research shows bisphosphonates can improve disease-free survival and overall survival.

The draft guideline, which is available for public consultation until 6 March, also recommends that women who are having a mastectomy should be offered breast reconstruction at the same time with all appropriate breast reconstruction options - whether or not these are available locally.

Breast cancer is the most common cancer in the UK, with approximately 54,000 new cases of invasive disease and around 7,000 new cases of pre-invasive disease diagnosed annually. Most of the breast cancers occur in women, but just over 300 men in the UK are also diagnosed with invasive breast cancer every year.

Early breast cancer, which is potentially curable, is diagnosed when the cancer is only found in the breast and the lymph nodes nearby (most often under the arm), and has not spread to other parts of the body. Most people diagnosed with breast cancer each year in the UK have early breast cancer.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “Although breast cancer survival rates have improved over recent decades, it remains the leading cause of death in women aged 35-49.

“Since the publication of NICE’s original guideline in 2009 there have been a number of advances in the way early breast cancer is managed and these are reflected in this updated guideline.”

Other new recommendations cover offering further surgery to extend the distance between a tumour and the edge of the surrounding tissue removed with it, offering drugs to stop the ovaries from producing oestrogen, and the use of taxanes alongside anthracycline-based chemotherapy in people with node-positive and node-negative breast cancer.

NHS organisations should compare their current practice with these recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.

Since the publication of NICE’s original guideline in 2009 there have been a number of advances in the way early breast cancer is managed and these are reflected in this updated guideline.

Professor Mark Baker, director of the centre for guidelines at NICE