Breast cancer risk in young women in the National Breast Screening Programme: implications for applying NICE guidelines for additional screening and chemoprevention.

Abstract

In the UK women at moderate and high risk of breast cancer between the ages of 40 and 49 are eligible for annual mammographic screening and preventive therapy with tamoxifen. Here we estimate the numbers of women in a population eligible for this service and the proportion of breast cancers detected in this group compared with the whole population. Women <50 attending for mammographic screening in the National Health Service Breast Screening Programme (NHSBSP) completed a risk questionnaire. The proportion at moderate and high risk according to National Institute of Health Care Excellence (NICE) guidelines was estimated. An estimate was also made using a different model of risk estimation (Tyrer-Cuzick). The numbers of cancers detected in the moderate/high risk groups were compared with numbers detected in the whole population Completed questionnaires were available for 4,360 women between ages 46-49. Thirty women (0.7%, 95% CI 0.5-1.0%) were at high-risk and 130 (3.0%, 2.5-3.5%) were at moderate risk according to NICE guidelines. Thirty seven cancers were detected by mammography in the whole group. Five of these were found in the moderate/high-risk group giving a 3.2 fold increase in detection compared with the standard risk group. More women were assigned to the moderate or high-risk group using the Tyrer-Cuzick model (N= 384), but the numbers of cancers in this group was not appreciably increased (N=8). Systematic assessment of family history in primary care or through population-based screening will identify appreciable numbers of women in their forties, eligible for additional surveillance and chemoprevention.