If breast cancer can be prevented, let’s do it

Advances in genetic research are encouraging new attention to family history

Share

When Angelina Jolie made the dramatic revelation that she had undergone a double mastectomy to reduce her risk of breast cancer, her decision was met with shock, but also with a good deal of admiration and respect. With a mother who had died from the disease in her 50s, tests showing that she herself carried one of the risky genes, and with surgery, as she said, reducing the likelihood of her contracting it from more than 80 to 5 per cent, her choice was understandable.

But not everyone with a family history of breast cancer will be prepared to contemplate such drastic action. So it is to the credit of the National Institute for Health and Care Excellence that it is offering a middle way. In a new guideline, Nice says that women in England and Wales who are over 35 and have a moderate or high risk of breast cancer should be considered for preventive drug therapy. They will be offered a five-year course of either tamoxifen or raloxifene – drugs that have been found to cut the risk of breast cancer by as much as 40 per cent. Surgery is already an option, but drugs are likely to be the preferred choice.

The new Nice guideline is welcome for several reasons; first, of course, because it could and should mean that breast cancer claims fewer lives. And if fewer women develop breast cancer in the first place, fewer will have to go through the gruelling and debilitating treatment that is now almost the only option.

A second reason is that it shows Nice doing the job it was set up to do: reviewing treatments and judging how NHS money can most effectively be spent. The two drugs mentioned are affordable and both have a proven record in treating breast cancer, even though they have not been expressly approved for prevention, at least in Britain. But Nice has clearly calculated that the lives, suffering and long-term treatment saved by the prophylactic use of these drugs will make economic, as well as medical, sense.

And a third, related, reason is that it signals a new attention to family history in health matters. As multiple GP practices have proliferated, and patients no longer always see the same GP, the likelihood that a doctor will be familiar with a patient’s family history has declined. A whole body of pertinent knowledge has thus been lost. Advances in genetic research and a realisation of the potential benefits to be reaped from genetic testing, however, are encouraging a new emphasis on family history. If this fosters prevention, as well as – it is to be hoped – leading the way to cures for diseases once regarded as  death sentences, that is a huge step forward.

With the news so generally positive, however, we would still urge a note of caution. A time can already be foreseen when drugs are precisely tailored to a patient’s genetic make-up and so rendered more effective and less wasteful. But a five-year course of preventive drug treatment for women judged to have a higher risk of breast cancer is quite a blunt instrument. Some, perhaps many, of those who opt for the treatment may not need it, and there may be long-term side-effects that are as yet undetected. This is not a question of money, but of health.

And a more general question arises over the idea of healthy people taking drugs solely for preventive purposes. Aspirin is one supposed “miracle” drug whose long-term use can produce damaging side-effects, and the notion that cholesterol-reducing statins bring only benefits is already being challenged. Some 50,000 women and 400 men are diagnosed with breast cancer every year and any serious attempt to reduce that is to be welcomed. But the choice for those with a family history of breast cancer may still be harder than it looks. 

 

React Now

Latest stories from i100
SPONSORED FEATURES
iJobs Job Widget
iJobs General

Recruitment Genius: Office / Sales Manager

£22000 - £32000 per annum: Recruitment Genius: Established and expanding South...

Recruitment Genius: Administrative Assistant / Order Fulfilment

£14000 per annum: Recruitment Genius: An exciting opportunity to join a thrivi...

SThree: Trainee Recruitment Consultant

£18000 - £23000 per annum + Uncapped OTE: SThree: Trainee Recruitment Consulta...

SThree: Trainee Recruitment Consultant

£18000 - £23000 per annum + Uncapped OTE: SThree: Trainee Recruitment Consulta...

Day In a Page

Read Next
 

Syria's Kurds have little choice but to flee amid the desolution, ruins and danger they face

Patrick Cockburn
A bartender serves two Mojito cocktails  

For the twenty-somethings of today, growing up is hard to do

Simon Kelner
Refugee crisis: David Cameron lowered the flag for the dead king of Saudi Arabia - will he do the same honour for little Aylan Kurdi?

Cameron lowered the flag for the dead king of Saudi Arabia...

But will he do the same honour for little Aylan Kurdi, asks Robert Fisk
Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

Humanity must be at the heart of politics, says Jeremy Corbyn
Joe Biden's 'tease tour': Could the US Vice-President be testing the water for a presidential run?

Joe Biden's 'tease tour'

Could the US Vice-President be testing the water for a presidential run?
Britain's 24-hour culture: With the 'leisured society' a distant dream we're working longer and less regular hours than ever

Britain's 24-hour culture

With the 'leisured society' a distant dream we're working longer and less regular hours than ever
Diplomacy board game: Treachery is the way to win - which makes it just like the real thing

The addictive nature of Diplomacy

Bullying, betrayal, aggression – it may be just a board game, but the family that plays Diplomacy may never look at each other in the same way again
Lady Chatterley's Lover: Racy underwear for fans of DH Lawrence's equally racy tome

Fashion: Ooh, Lady Chatterley!

Take inspiration from DH Lawrence's racy tome with equally racy underwear
8 best children's clocks

Tick-tock: 8 best children's clocks

Whether you’re teaching them to tell the time or putting the finishing touches to a nursery, there’s a ticker for that
Charlie Austin: Queens Park Rangers striker says ‘If the move is not right, I’m not going’

Charlie Austin: ‘If the move is not right, I’m not going’

After hitting 18 goals in the Premier League last season, the QPR striker was the great non-deal of transfer deadline day. But he says he'd preferred another shot at promotion
Isis profits from destruction of antiquities by selling relics to dealers - and then blowing up the buildings they come from to conceal the evidence of looting

How Isis profits from destruction of antiquities

Robert Fisk on the terrorist group's manipulation of the market to increase the price of artefacts
Labour leadership: Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea

'If we lose touch we’ll end up with two decades of the Tories'

In an exclusive interview, Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea
Tunisia fears its Arab Spring could be reversed as the new regime becomes as intolerant of dissent as its predecessor

The Arab Spring reversed

Tunisian protesters fear that a new law will whitewash corrupt businessmen and officials, but they are finding that the new regime is becoming as intolerant of dissent as its predecessor
King Arthur: Legendary figure was real and lived most of his life in Strathclyde, academic claims

Academic claims King Arthur was real - and reveals where he lived

Dr Andrew Breeze says the legendary figure did exist – but was a general, not a king
Who is Oliver Bonas and how has he captured middle-class hearts?

Who is Oliver Bonas?

It's the first high-street store to pay its staff the living wage, and it saw out the recession in style
Earth has 'lost more than half its trees' since humans first started cutting them down

Axe-wielding Man fells half the world’s trees – leaving us just 422 each

However, the number of trees may be eight times higher than previously thought
60 years of Scalextric: Model cars are now stuffed with as much tech as real ones

60 years of Scalextric

Model cars are now stuffed with as much tech as real ones