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
iJobs Job Widget
iJobs General

Senior Risk Manager - Banking - London - £650

£600 - £650 per day: Orgtel: Conduct Risk Liaison Manager - Banking - London -...

Commercial Litigation Associate

Highly Attractive Package: Austen Lloyd: CITY - COMMERCIAL LITIGATION - GLOBAL...

Systems Manager - Dynamics AX

£65000 - £75000 per annum + Benefits: Progressive Recruitment: The client is a...

Service Delivery Manager (Software Development, Testing)

£40000 - £45000 per annum: Ashdown Group: A well-established software house ba...

Day In a Page

Read Next
The economy expanded by 0.8 per cent in the second quarter of 2014  

British economy: Government hails the latest GDP figures, but there is still room for skepticism over this 'glorious recovery'

Ben Chu
Comedy queen: Miranda Hart has said that she is excited about working on the new film  

There is no such thing as a middle-class laugh

David Lister
Evan Davis: The BBC’s wolf in sheep’s clothing to take over at Newsnight

The BBC’s wolf in sheep’s clothing

What will Evan Davis be like on Newsnight?
Finding the names for America’s shame: What happens to the immigrants crossing the US-Mexico border without documents who never make it past the Arizona desert?

Finding the names for America’s shame

The immigrants crossing the US-Mexico border without documents who never make it past the Arizona desert
Inside a church for Born Again Christians: Speaking to God in a Manchester multiplex

Inside a church for Born Again Christians

As Britain's Anglican church struggles to establish its modern identity, one branch of Christianity is booming
Rihanna, Kim Kardashian and me: How Olivier Rousteing is revitalising the house of Balmain

Olivier Rousteing is revitalising the house of Balmain

Parisian couturier Pierre Balmain made his name dressing the mid-century jet set. Today, Olivier Rousteing – heir to the house Pierre built – is celebrating their 21st-century equivalents. The result? Nothing short of Balmania
Cancer, cardiac arrest, HIV and homelessness - and he's only 39

Incredible survival story of David Tovey

Tovey went from cooking for the Queen to rifling through bins for his supper. His is a startling story of endurance against the odds – and of a social safety net failing at every turn
Backhanders, bribery and abuses of power have soared in China as economy surges

Bribery and abuses of power soar in China

The bribery is fuelled by the surge in China's economy but the rules of corruption are subtle and unspoken, finds Evan Osnos, as he learns the dark arts from a master
Commonwealth Games 2014: Highland terriers stole the show at the opening ceremony

Highland terriers steal the show at opening ceremony

Gillian Orr explores why a dog loved by film stars and presidents is finally having its day
German art world rocked as artists use renowned fat sculpture to distil schnapps

Brewing the fat from artwork angers widow of sculptor

Part of Joseph Beuys' 1982 sculpture 'Fettecke' used to distil schnapps
BBC's The Secret History of Our Streets reveals a fascinating window into Britain's past

BBC takes viewers back down memory lane

The Secret History of Our Streets, which returns with three films looking at Scottish streets, is the inverse of Benefits Street - delivering warmth instead of cynicism
Joe, film review: Nicolas Cage delivers an astonishing performance in low budget drama

Nicolas Cage shines in low-budget drama Joe

Cage plays an ex-con in David Gordon Green's independent drama, which has been adapted from a novel by Larry Brown
How to make your own gourmet ice lollies, granitas, slushy cocktails and frozen yoghurt

Make your own ice lollies and frozen yoghurt

Think outside the cool box for this summer's tempting frozen treats
Ford Fiesta is UK's most popular car of all-time, with sales topping 4.1 million since 1976

Fiesta is UK's most popular car of all-time

Sales have topped 4.1 million since 1976. To celebrate this milestone, four Independent writers recall their Fiestas with pride
10 best reed diffusers

Heaven scent: 10 best reed diffusers

Keep your rooms smelling summery and fresh with one of these subtle but distinctive home fragrances that’ll last you months
Commonwealth Games 2014: Female boxers set to compete for first time

Female boxers set to compete at Commonwealth Games for first time

There’s no favourites and with no headguards anything could happen
Five things we’ve learned so far about Manchester United under Louis van Gaal

Five things we’ve learned so far about United under Van Gaal

It’s impossible to avoid the impression that the Dutch manager is playing to the gallery a little