GPs across England fail to spot 95% of women who go on to receive a breast cancer diagnosis

The majority of women who go on to develop the disease aren't being flagged for testing or preventative intervention

Research conducted by the University of Cambridge and the Institute of Cancer Research in London has revealed that the NICE guidelines relied upon by GPs across England fail to identify 95 per cent of women under 50 who will go on to receive a breast cancer diagnosis.

The study, published in the British Journal of Cancer, found that the existing referral criteria used to direct younger women towards further risk assessment and specialist care are woefully inadequate.

According to the analysis, the overwhelming majority of women in this age group who develop the disease within a decade are simply not being flagged for early testing or preventive intervention.

The findings have prompted researchers to call for an urgent reassessment of the criteria that currently govern GP referrals.

The principal reason for this glaring gap lies in the heavy reliance on family history as the cornerstone of NICE's referral framework.

The research found that nearly three-quarters — 73 per cent — of women under 50 who develop breast cancer within ten years have no familial connection to the disease whatsoever.

This renders the existing criteria fundamentally ill-suited to catching the majority of at-risk younger women.

A more comprehensive risk assessment tool called Boadicea, developed at Cambridge with funding from Cancer Research UK, was able to identify eight times as many women in this age group who would subsequently be diagnosed.

Unlike the current NICE approach, Boadicea incorporates a broader range of factors, including reproductive history, lifestyle considerations and genetic data, offering a far more nuanced picture of individual risk.

Dr Juliet Usher-Smith, of the University of Cambridge, said: "We need to get better at identifying women at highest risk of breast cancer so that we can intervene early, when there are more options for treating, or even preventing, their disease.

"The current NICE criteria used in general practice are missing up to 95 per cent of women under 50 who will go on to develop breast cancer. It's time to look again at these criteria in the light of our findings."

Prof Montserrat García-Closas, of the ICR, acknowledged the practical complexities involved. "There will be a balance to strike: the NICE criteria are much easier to implement, but miss a large proportion of women at elevated risk. But a full risk assessment including genetic testing will place a heavy burden on resources.

"Ultimately, it will be a trade-off between the practical, resource, and cost implications of data collection and risk assessment, and the potential benefits and harms associated with accurate and inaccurate classification of women."

Breast cancer remains the most prevalent cancer globally, representing roughly one in four cancer cases and ranking among the leading causes of death for women below the age of 50. Early identification of those at heightened risk opens the door to additional screening and preventive measures that can prove decisive.

Dr Simon Vincent, chief scientific officer at Breast Cancer Now, which supported the research, stressed the significance of the results.

"These findings highlight the limitations of Nice's current referral criteria, and so this research must now be carefully considered as part of the current review of its family history guidelines.

"However, it's equally important that any changes come with the needed investment in family history services, so they can be implemented effectively and fairly across the NHS."

Nice itself responded to the study with measured language, welcoming the research whilst stopping short of committing to immediate action.

A spokesperson for the body said: "Nice welcomes the findings of this study and recognises the potential of multifactorial risk models in improving the identification of women at increased risk of breast cancer in the future.

"However, the current evidence does not warrant a change to our existing familial breast cancer guideline at this time. Nice remains committed to reviewing new evidence and will consider further updates as more data on feasibility and clinical outcomes become available."

The response suggests that, despite the striking findings, any shift in how GPs assess breast cancer risk in younger women may yet be some way off — leaving a significant gap in early detection that researchers believe demands more urgent attention.