The National Institute for Health and Care Excellence (NICE) has today published new draft recommendations for the diagnosis and management of early and locally advanced breast cancer.
Early breast cancer is diagnosed when the cancer is only found in the breast and the lymph nodes nearby (most often under the arm), and has not spread to other parts of the body, where it unfortunately becomes incurable.
The draft guideline, which is open for public consultation until 6 March, offers a number of key updates on previous clinical recommendations published in 2009. These include the extension of aromatase inhibitor therapy for some women to further reduce the risk of recurrence, the use of bisphosphonates for a small group of patients to help prevent the disease spreading to the bone, and the recommendation that all women who are having a mastectomy be offered the choice of immediate breast reconstruction along with full information about all appropriate reconstructive surgery options.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
“These are really important steps in the right direction for patients with early-stage breast cancer. This update offers significant and much-needed guidance to help doctors and healthcare professionals translate critical research breakthroughs to NHS patients. If now funded and implemented across the country, these steps could save and improve thousands more women’s lives.
“That major new evidence showing that extending hormone therapy can reduce the risk of the disease returning years later has prompted a swift change in what NHS patients will be offered is really promising. But the side-effects of these treatments can be incredibly gruelling for many women – so it’s essential that all patients are able to fully discuss the risks and benefits with their doctors, and are supported to make the decision that’s right for them.
“It’s also fantastic to see renewed focus on supporting patients to actively reduce their risk of recurrence through healthy lifestyle choices. Keeping physically active, limiting alcohol intake and maintaining a healthy weight can all help lower the chances of breast cancer coming back. But hormone therapies can have a big impact on weight and it can be hard for many to keep active when struggling with nausea, so we need to do much more to support patients living with and beyond breast cancer to stack the odds in their favour as best they can.
“Following years of campaigning, we’re also delighted that the guidance recommends post-menopausal patients with node-positive breast cancer be offered bisphosphonates to help prevent the spread of the disease to the bone. But, given the potential to cut 10% of all breast cancer deaths in the UK, it is disappointing that it does not recommend this treatment be routinely offered to a wider group of women. These are cheap, well-tolerated and widely-available drugs, proven to reduce the risk of breast cancer spreading, where it then becomes incurable. The sooner we offer them to all women who could benefit, the sooner we will stop more women dying from breast cancer.
“Similarly, any move to replace Clinical Nurse Specialists with ‘key workers’ for patients would be particularly concerning. While the change to key workers may go some way to addressing the workforce shortages in nurse specialists, this must not come at the expense of clinical care, as we know just how much patients value the support they receive from their CNS.”
On the recommendation to offer all women with option of immediate reconstruction following a mastectomy, Baroness Morgan added:
“Offering all women the option of immediate reconstruction following a mastectomy is also major progress towards improving patient choice. Most women opt not to have reconstruction, but for many it can have a significant psychological impact and form a key part of their cancer treatment. It’s so important that patients are fully involved in decision-making with their doctors about whether to have reconstruction, and they must be given all the information they need about the range of options available to them.”
Read a summary of the NICE draft guidance on early and locally advanced breast cancer diagnosis and management.