title: Breast cancer risk in young women in the national breast screening programme: implications for applying NICE guidelines for additional screening and chemoprevention.
abstract: In the United Kingdom, women at moderate and high risk of breast cancer between the ages of 40 and 49 years are eligible for annual mammographic screening and preventive therapy with tamoxifen. Here, we estimate the numbers of women in a population eligible for this service and the proportion of breast cancers detected in this group compared with the whole population. Women <50 attending for mammographic screening in the National Health Service Breast Screening Programme (NHSBSP) completed a risk questionnaire. The proportion at moderate and high risk according to National Institute of Health Care Excellence (NICE) guidelines was estimated. An estimate was also made using a different model of risk estimation (Tyrer-Cuzick). The numbers of cancers detected in the moderate/high risk groups were compared with numbers detected in the whole population. Completed questionnaires were available for 4,360 women between ages 46 and 49 years. Thirty women [0.7%; 95% confidence interval (CI), 0.5-1.0%] were at high risk and 130 (3.0%, 2.5-3.5%) were at moderate risk according to NICE guidelines. Thirty-seven cancers were detected by mammography in the whole group. Five of these were found in the moderate-/high-risk group giving a 3.2-fold increase in detection compared with the standard risk group. More women were assigned to the moderate- or high-risk group using the Tyrer-Cuzick model (N = 384), but the numbers of cancers in this group were not appreciably increased (N = 8). Systematic assessment of family history in primary care or through population-based screening will identify appreciable numbers of women in their forties, eligible for additional surveillance and chemoprevention.
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. Genetic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St. Mary's Hospital, Manchester, United Kingdom. Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Withington, Manchester, United Kingdom. gareth.evans@cmft.nhs.uk.
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Brentnall
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Harvie
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dawe
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, United Kingdom. NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Sergeant
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom.
authors.forename: Paula
authors.initials: P
authors.lastname: Stavrinos
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Astley
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom.
authors.forename: Mary
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Institute of Population Health, University of Manchester, Oxford Road, Manchester, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Ainsworth
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Institute of Population Health, University of Manchester, Oxford Road, Manchester, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom.
authors.forename: Louise S
authors.initials: LS
authors.lastname: Donnelly
authors.affiliation: Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Withington, Manchester, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Howell
mesh_terms: D000328:Adult; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D018890:Chemoprevention / Q000592:standards*; D055088:Early Detection of Cancer / Q000592:standards; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013629:Tamoxifen / Q000008:administration & dosage; D006113:United Kingdom
chemical_list: D013629:Tamoxifen