New NICE Guidance for Breast Cancer

Peter Russell

July 18, 2018

Updated guidelines on the diagnosis and management of early and locally advanced breast cancer in England have been issued by the National Institute for Health and Care Excellence (NICE).

Among the main recommendations are that:

  • Postmenopausal women with ER-positive invasive breast cancer who have been taking tamoxifen for 2 to 5 years and who are at medium or high risk of the disease returning should be offered extended hormonal therapy with an aromatase inhibitor.

  • Postmenopausal women with invasive breast cancer that has spread to nearby lymph nodes or who have a high risk of the cancer returning should be offered bisphosphonates alongside their chemotherapy, reflecting evidence that bone-modifying agents improve disease-free survival and overall survival.

  • Women who are having a mastectomy should be offered immediate or delayed breast reconstruction options whether or not they are available locally. The benefits and risk of these options should be discussed and healthcare professionals should be aware that some women may prefer not to have breast reconstruction surgery.

Surgery Restrictions

The new guidance on breast reconstruction followed a recent analysis by the research charity Breast Cancer Now which highlighted surgery restrictions for patients in some parts of England. The report found that some local health bodies were rushing women into making difficult and life-changing choices by placing time limits on when breast reconstruction surgery had to be completed.

Breast cancer is the most common cancer in the UK, with around 55,000 new cases of the disease diagnosed each year. Most breast cancers occur in women, but there were 370 new cases among men in 2015.

Breast Cancer Care said it was "wonderful" that the new guidance had reflected recommendations from cancer charities. It praised NICE for recommending that younger women with breast cancer should be told about the risk to fertility and to have the chance to discuss their fertility options with a specialist.

Symptoms of Breast Cancer

However, it said there was a missed opportunity to make women with breast cancer aware of the later stages of the disease. The charity's Chief Executive, Samia al Qadhi, said that "over half of women with secondary incurable breast cancer did not know the signs and symptoms of the disease" and that "excluding clear, specific guidance on this is a devastating oversight. More awareness is crucial as, if the cancer does return, leaving it undiagnosed and untreated for longer means the spread can continue and symptoms worsen. 

"With another guidance update not planned for years, it is vital NICE goes the distance and ensures women get all the information sooner so they’re not left in the dark." 

According to NICE, NHS organisations should compare their current practice with these recommendations and consider what changes may need to be made to put them into practice.

It said they should take into account extra costs as well as the savings they could make.

It acknowledged that the speed of uptake would depend on financial resources available and other health priorities they had to deal with.


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