‘Risk-reducing' surgery could prevent thousands of breast cancer cases
This intervention, known as a mastectomy, is currently used to treat existing cancer or offered to those with a high genetic predisposition, specifically women carrying the BRCA1, BRCA2, or PALB2 genes.
The analysis indicates that approximately 6,500 cases of breast cancer could be prevented annually if preventative mastectomies were more widely adopted.
Crucially, the research proposes expanding eligibility beyond the currently recognised genetic markers.
Women with other genes linked to increased risk, such as ATM, CHEK2, RAD51C, and RAD51D, may also benefit.
Furthermore, the study highlights that a combination of other factors, including a family history of breast cancer, parity (number of children), breastfeeding history, and mammogram density, should be considered in assessing a woman's overall high risk for the disease, potentially making them candidates for risk-reducing mastectomies.
Women in the UK have an 11 per cent chance of developing breast cancer across their lifetime.
Medics can calculate a woman's risk of breast cancer using tools which combine the effect of various risk factors.
Researchers from Queen Mary University of London and the London School of Hygiene and Tropical Medicine (LSHTM) found that if health officials could identify all women aged 30 to 55 who have a 35 per cent or higher risk of breast cancer, and they all went on to have RRM, then an estimated 6,538 breast cancer cases could be prevented in the UK each year.
This is the equivalent of around 11 per cent of the 59,000 women in the UK who are diagnosed with breast cancer each year.
The academics point out that women who have one of the other genes linked to breast cancer, who may be at high risk of disease, could potentially be found by a mechanism called 'cascade testing' – where genetic tests are offered to family members of women who have been found to have these different genes linked to breast cancer.
The economic evaluation study, published in the journal JAMA Oncology, concludes: 'Undergoing RRM appears cost-effective for women at 30-55 years with a lifetime BC-risk 35 per cent (or more).
'The results could have significant clinical implications to expand access to RRM beyond BRCA1/BRCA2/PALB2 pathogenic variant carriers.'
Corresponding author on the paper, Professor Ranjit Manchanda, professor of gynaecological oncology at Queen Mary and consultant gynaecological oncologist, said: 'We for the first time define the risk at which we should offer RRM.
'Our results could have significant clinical implications to expand access to mastectomy beyond those patients with known genetic susceptibility in high penetrance genes- BRCA1/ BRCA2/ PALB2 – who are traditionally offered this.
'This could potentially prevent can potentially prevent (around) 6500 breast cancer cases annually in UK women.
'We recommend that more research is carried out to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group'.
Dr Rosa Legood, associate professor in health economics at LSHTM, added: 'Undergoing RRM is cost-effective for women (aged) 30 to 55-years with a lifetime breast cancer risk of 35 per cent or more.
'These results can support additional management options for personalised breast cancer risk prediction enabling more women at increased risk to access prevention.'
Women deemed to be at high risk of breast cancer can also be offered regular screening and medication.
Louise Grimsdell, Breast Cancer Now senior clinical nurse specialist, said: 'While this modelling provides valuable insights into the cost-effectiveness of risk-reducing mastectomy for women with a high risk of developing breast cancer, each individual must be offered all risk-management options that are suitable for them.
'Choosing to have risk-reducing surgery is a complex and deeply personal decision that comes with emotional and physical implications.
'So, it's vital women can consider all their options, including screening and risk-reducing medications, and are supported by their clinician to make an informed decision that's right for them.
'It's also crucial that the unacceptably long waits that far too many women who chose risk-reducing surgery are facing are urgently tackled.'
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