Long-awaited recommendations on which women should receive the breast cancer drug Herceptin are to be issued tomorrow.
Thousands of patients who could benefit from the treatment are hoping that the National Institute for Health and Clinical Excellence (Nice) will say all those with suitable early-stage breast cancer should be entitled to receive it on prescription.
But there are concerns that NHS trusts, which are already struggling with multimillion-pound deficits, will continue to restrict access to the drug, which costs £20,000 a year per patient. The Government says there will be no extra money to fund the Nice guidance on Herceptin and the cost must be found from existing budgets.
Dr Gill Morgan, chief executive of the NHS Confederation, said: "Without doubt, this will present a significant financial challenge to some organisations. The problem is that organisations have to plan their expenditure 18 months in advance and so when a drug is fast-tracked through the process - as this drug has been -it causes several difficulties.
"Trusts don't want to put too much money aside in case they end up in surplus with funds that could have gone to patient care but they have to make a guess because if they end up in deficit it is as bad and some other service has to be cut."
Roche, the maker of Herceptin, was granted a licence for its use in treating early-stage breast cancer by the European Medicines Agency last week.
The drug is already used in cases of advanced breast cancer but studies have shown that it can dramatically reduce the risk of the disease returning in women diagnosed at an earlier stage.
Women with early-stage disease have been forced to go to the High Court to seek the right to the treatment because NHS trusts have said the lack of a relevant licence meant they were under no obligation to provide it.
Under pressure from patients and ministers, Nice has fast-tracked assessment of the data on Herceptin for early breast cancer. More than 5,000 women a year diagnosed with early-stage, HER-2 positive breast cancer - an aggressive type - could benefit from Herceptin.