Update to U.K. Health Guideline Recommends Tamoxifen or Raloxifene for Risk Reduction

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The United Kingdom’s National Institute for Health and Clinical Excellence (NICE) has updated its guideline for people with a family history of breast cancer. The guideline now includes changes that would improve preventive care options to more closely match what’s available in other countries, including the United States.

The update is good news for people with an elevated risk for developing breast cancer in England, Wales, and Northern Ireland because by law, the National Health Service must provide funding for treatments recommended by NICE.

Among the changes included in the new update are those that address:

  • The use of tamoxifen or raloxifene as treatments to reduce the risk of breast cancer: The guideline would now allow women who have not had breast cancer but who are at high risk of developing the disease to take tamoxifen or raloxifene for 5 years. Research has recently confirmed that tamoxifen and raloxifene reduce the risk of breast cancer coming back (recurrence) during the standard 5 years of treatment, and that recurrence risk stays lower during the next 5 years after tamoxifen treatment ends.

    While using tamoxifen and raloxifene for risk reduction is already common practice in the United States and many other countries, neither drug is yet approved for this use in the United Kingdom.
  • When to offer genetic testing: The guideline now states that genetic testing be offered to people who have a family member with breast or ovarian cancer and at least a 10% combined likelihood of carrying abnormal BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) genes.
  • What screening tests should be offered: The guideline expands the availability of mammogram and breast MRI. Specifically, the guideline states that annual MRI surveillance should now be offered to all women up to 49 years of age who have an increased risk for developing breast cancer. It also states that annual mammography should be offered for women aged 50–69 years with an increased risk for developing breast cancer.

The new guideline updates earlier versions published by NICE in 2004 and 2006. The final guideline is expected later this year.

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