Call For New Guidelines
Call For New Guidelines For Women At High Risk Of Breast Cancer
The Breast Cancer Research Trust is calling for the development of updated, user-friendly New Zealand guidelines for use in general practice to help in reassuring women with a strong family history of breast cancer.
This follows the announcement of new guidelines by the National Institute for Clinical Excellence in the United Kingdom yesterday. The changes include some women in their forties with a family history receiving annual screening. Currently UK women are only offered screening every three years over the age of 50 years.
Dr Jackie Blue from the Breast Cancer Research Trust and an Auckland-based breast physician, says most women over-estimate their personal risk of breast cancer, however women who are confirmed as having a high risk of developing the disease need to be seen by a breast specialist for regular surveillance.
“Although here in New Zealand we are ahead of the UK with all women from 45 years to receive free screening through BreastScreen Aotearoa, this is still not enough for women with the genetic risk factor.”
Most breast cancers develop as a random, one-off event. Women with strong family histories account for only 1% of the female population, but 5% of breast cancer cases. The main features of genetic breast cancer are breast cancer before the age of 40 years, bilateral breast cancer, ovarian breast cancer and male breast cancer.
As well as annual mammography and clinical breast examination they may require breast ultrasound or other investigations. Referral to a genetic counsellor for genetic testing must also be offered.
Dr Blue comments it is concerning that genetic services are currently woefully under resourced in New Zealand.
“In my experience prophylactic (precautionary) mastectomy is a major decision and many women who are at an extremely high risk of developing breast cancer are reluctant to choose this as an option and elect to continue with close surveillance.”
For Dr Blue, there are still many concerns with the use of drugs to prevent breast cancer such as life-threatening drug side effects, unknown long term side-effects, when to start/stop the drug and what to offer after finishing.
"Women at high risk of developing breast cancer, as well as having regular surveillance by a breast specialist, urgently need information and support," says Dr Blue.