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Is the NHS Breast Cancer Screening Policy failing to protect older women?

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    A recent breast cancer risk test devising a 77-gene analysis has been heralded as a ‘major step’ in calculating the probability of women developing breast cancer. But is the NHS’s screening policy lagging behind research and leaving older women at risk?

    By Ben Lees

Research results

The research (published in the Journal of the National Cancer Institute) analysed 77 genes which individually were not significantly indicative of cancer risk, but were highly indicative when considered together.

The test devised as a result of the research allowed the international team (led by the Institute of Cancer Research in London and the University of Cambridge) to calculate the risk of women developing cancer:

• In women with no family history of breast cancer, the highest risk group had a 16.6 % lifetime risk

• In women with no family history of breast cancer, the lowest risk group had a 5.2% lifetime risk

• In women with a family history of breast cancer, the higher risk group had a 24.2% lifetime risk

• In women with a family history of breast cancer, the lowest risk group had a 8.2% lifetime risk

Professor Douglas Easton, of the University of Cambridge said: “we’ve now reached a crucial stage at which all this research can be combined to help target screening and advice to those women who need it most”.

The age factor

This, on the face of it, is a major step in the right direction. However, a recent report by the All-Party Parliamentary Group (APPG) on Breast Cancer criticised the NHS for doing too little to prevent the disease in women over the age of 70, who make up half of all deaths from breast cancer.

Currently, women between the ages of 50 and 70 are offered regular mammograms (with pilot schemes testing for an expanded age group – those aged 47 to 50, and those between 70 and 73). But despite calls from the APPG two years ago for the age to be extended to 76, this has not been acted upon.

Diana Jupp, director of campaigns and services at Breast Cancer Care, said: “it is unacceptable that, in 2015, a breast cancer patient does not get the best care and treatment simply because of how old they are…”

She added that: “Breast cancer risk increases with age and older women have poorer survival [rates], so we absolutely must get this right”.

What should be done?

I am obviously encouraged by the recent gene testing developments, and recognise their potential for targeting screening and advice to those women who need them most. However, unless this is reflected in the screening policy adopted by the NHS, the impact of the research will remain theoretical.

We already know that half the deaths from breast cancer occur in those over 70 and this age group must therefore be, by definition, high risk. Yet regular screening is not routinely available for women over 70.

I wholeheartedly agree with the calls from the APPG to extend regular screening age to 76 and hope that recent developments in gene testing will serve as an impetus for the Health Service to overhaul their breast cancer screening policy, and direct services to those most in need.

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