Familial breast cancer surveillance - NICE update

24 May 2006

The National Institute for Health and Clinical Excellence (NICE) has issued a draft partial update of the clinical practice guideline on Familial breast cancer (CG14), in development for use in the NHS in England and Wales. This is an update to the guidance issued in 2004, and stipulates when MRI (magnetic resonance imaging) should be offered as a surveillance measure in addition to or in place of mammography, as per the original guideline. The 2004 guidelines did not recommend the use of MRI in routine surveillance on the basis of the evidence available at the time, but this has now been reviewed, with the conclusion that MRI screening can increase sensitivity (albeit at the expense of specificity) of tumour detection; other evidence has suggested that the sensitivity of mammographic screening is partially compromised among younger women due to a generally denser breast tissue.

NICE therefore reviewed the effectiveness and cost effectiveness of MRI and MRI with mammography compared with mammography alone as a surveillance measure for women at increased risk of breast cancer.It is proposed that annual MRI screening should be offered to women in different age categories according to the following criteria:

Age under 30
  • Those at exceptionally high risk (i.e. annual risk greater or equal to 1%) for example TP53 mutation carriers.
Age 30-39
  • BRCA1 and BRCA2 mutation carriers
  • Those at 50% risk of carrying a BRCA1 mutation
  • Those with a risk over ten years of greater than 8%
    Those at 50% risk from untested families with at least a 60% risk of a BRCA1 mutation (i.e. a 30% chance of carrying a mutation themselves).
Age 40-49
  • BRCA1 and BRCA2 mutation carriers
  • Those at 50% risk of carrying a BRCA1 mutation
  • Those with a risk over ten years of greater than 20%
    Those with a genetic history suggesting a risk over ten years of greater than 12% where mammography has shown a dense breast pattern

Individuals and organisations not registered as stakeholders are invited to comment on the updated parts of the guidelines via the most appropriate registered stakeholder organisation.

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