Young women at risk of the genetic form of breast cancer could be spared the trauma of preventative mastectomies under a ruling this week which is expected to offer a new annual screening system.
The NHS watchdog, the National Institute for Clinical Excellence (NICE), is set to recommend that women aged between 30 and 49 should be offered annual magnetic resonance imaging (MRI) scans for the early detection of tumours.
Until now the safest option for carriers of the rogue genes, which can cause aggressive tumours at a young age, has been to have healthy breasts removed in the hope of avoiding any future disease. Many patients and doctors regard the operation as mutilation, but standard mammograms - routinely used on older women and offered to some younger women at high risk - are not nearly as reliable as MRI at scanning the dense tissue of young women.
The MRI scans are, however, almost 10 times as expensive as mammograms, raising questions about how the NHS would pay for them.
NICE's draft guidelines note that while there are relatively few young women at high risk - about 1 per cent of women carry either the BRCA1 or BRCA2 genes identified as helping cause breast cancer - there is 'an issue with regards to the provision of these services'.
Breast cancer charities said the move was crucial. 'We hope this will provide some clarity to these women over the services they can receive,' said Dr Sarah Rawlings, head of policy at Breakthrough for Breast Cancer. 'Preventative surgery is a drastic option, but many of these women have seen other members of their family be diagnosed and die from breast cancer and they want the reassurance of being able to say "I have done as much as I possibly can".'
The ruling follows debate over the value of the broader breast cancer screening programme, under which all women between 50 and 70 - the age group most at risk from the more common, non-genetic form of cancer - are invited for annual mammograms. Research published last week concluded some were undergoing unnecessary treatment as a result, prompting the government's cancer chief Professor Mike Richards to question the programme's future.
However, Rawlings said the issues were very different for women with the rogue gene: while an average woman has an 11 per cent chance of breast cancer, women with the gene have up to an 85 per cent risk: 'For many women, the benefits of screening will outweigh any risk: for women with a very strong family history, the benefits of screening far outweigh the risks of going on to develop breast cancer.' Currently women with the rogue gene are offered mammography over the age of 40, but not the more sensitive MRI which is routinely offered to high-risk women in the US.
Recent trials reported in the Lancet magazine found using MRI together with mamography caught 94 per cent of cancers in younger women, while mammograms alone only picked up 40 per cent. Unlike rulings on drugs, which health authorities must obey, NICE rulings on procedures such as screenings are merely best practice. That means some authorities could decide the MRI scans are too expensive and fail to offer them - as happened when NICE recommended that infertile women should be entitled to three free cycles of IVF.
A Department of Health spokesman refused to comment on the ruling until it was published. But he said ministers did not accept Richards' call for the entire breast cancer screening programme to be reviewed. A spokeswoman for NICE also declined to comment.
