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Original poster

New Boadicea breast cancer model: Study shows women under 50 not being referred under current NICE criteria

9 replies

AngleofRepose · 04/08/2026 11:38

This is about Boadicea, a new risk assessment tool for breast cancer symptoms. Compared to NICE critery, apparently Boadicea picks up more women under 50 who should be referred for further examination. The article is about England only.

https://news.sky.com/story/women-under-50-at-risk-of-breast-cancer-are-not-being-referred-study-13569611

Women under 50 at risk of breast cancer are not being referred - study

"The University of Cambridge analysis suggests the NICE criteria miss up to 95% of women at higher risk of developing the disease. This means they are not being referred for further tests or specialist care....

Researchers analysed data from 1,258 women under 50 who took part in the Breast Cancer Now Generations Study between 2004 and 2011....

The analysis, published in the British Journal of Cancer, suggests that using the Boadicea model for all women under 50 would lead to 26.5% being classed as above-population level risk and referred for further assessment.

This includes almost 35% of women under 50 who develop breast cancer within a decade....

Meanwhile, researchers found the current NICE criteria would result in 1.4% of women being referred for tests, including 4.4% who go on to develop breast cancer."

ed. random text

OP posts:
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anyolddinosaur · Yesterday 09:56

I thought the price was interesting as it's an upper limit on what it would cost the NHS. I'd expect economies of scale to knock that down considerably. edit for typo, others may be available.

mids2019 · Yesterday 06:22

https://pubmed.ncbi.nlm.nih.gov/41795013/
Here is a paper of breast cancer risk performance algorithms which you may find useful.

I always think with these type of discussions there is an silent of not reusing experts who feed into national cancer detection policy and maybe having trust they are able to make correct decision given their depth of knowledge in medicine and importantly medical statisrics.

Performance of breast cancer risk prediction algorithms across mammography systems in the UK screening programme - PubMed

Thirty percent of interval breast cancers, diagnosed between routine screening mammograms, have a poorer prognosis than screen-detected cancers. Deep learning algorithms can estimate short-term risk from negative mammograms to guide supplemental imagin...

https://pubmed.ncbi.nlm.nih.gov/41795013/

Original poster
AngleofRepose · 06/08/2026 15:54

anyolddinosaur · 06/08/2026 11:48

The genetic test used is available privately at a cost of £299 from https://preventcancer.co.uk/breast/ (other providers may be available). Obviously no radiation risk from the blood test but if you then go on to have mammograms there will be.

Be interesting to say the results by age and whether it gives a better risk profile if restricted to 40-50 year old women.

Steep! And out of reach for a lot of women, but at least it can be done. Thanks for this.

OP posts:
anyolddinosaur · 06/08/2026 11:48

The genetic test used is available privately at a cost of £299 from https://preventcancer.co.uk/breast/ (other providers may be available). Obviously no radiation risk from the blood test but if you then go on to have mammograms there will be.

Be interesting to say the results by age and whether it gives a better risk profile if restricted to 40-50 year old women.

Personalised Breast Cancer Prevention - Prevent Cancer UK

Personalised breast cancer prevention with genetic risk assessment can give early warning to women at risk even if there is no cancer in the family. It guides you towards tailored screening and prevention based on personal risk level.

https://preventcancer.co.uk/breast/

Original poster
AngleofRepose · 06/08/2026 10:10

ErrolTheDragon · 06/08/2026 10:00

It sounds as though the main change needed is to de-emphasise the family history element of the NICE guidelines and do more genetic testing - which presumably is way cheaper now than in the past?

You would think so, but they were just starting to talk about genetic testing when I was diagnosed nearly 20 years ago, and it seems that NICE have not moved on in their criteria since then. I know that research and treatment are now miles ahead of what they were two decades ago, so the issue, it seems to me, is getting the research and treatment to the women.

Which you can't do, if you're stuck on decades-old criteria. This is why they are missing a lot of younger women.

And, surely, lifestyle choices have changed since the last generation? Younger women are no longer smoking, but vaping, and young people don't drink nearly as much as Millennials did/do. There's a lot that has changed.

For NICE to just say "nope, thanks, we're fine as we are" is reckless. I suspect it's more about no staff or funding to take on a new model. It's always about money. And women pay that price.

Would they work harder to adopt a new model if it were for prostate cancer? Would they fund it? Hmmm...

OP posts:
ErrolTheDragon · 06/08/2026 10:00

It sounds as though the main change needed is to de-emphasise the family history element of the NICE guidelines and do more genetic testing - which presumably is way cheaper now than in the past?

Original poster
AngleofRepose · 06/08/2026 09:35

BBC report on this:

"This study, by a team from Cambridge University and the Institute of Cancer Research, looks at how to predict breast cancer risk in younger women.

They used a risk calculator called Boadicea that combines factors such as family history, lifestyle, reproductive history and genetic information to give a risk score.

If all women under 50 were to have this done, they estimate about a quarter (26.5%) would be categorised as at above-average risk and referred for further assessment.

This would include a third of women under 50 (34.8%) who develop breast cancer within 10 years.

By comparison, the current Nice criteria would result in 1.4% of women under 50 being referred for further assessment, which would include just 4.4% of those women who develop breast cancer.

A main reason for the disparity, the researchers say, is because three-quarters of women (73%) under 50 who develop breast cancer within a decade have no family history of breast cancer - the key criterion in the Nice guidelines.
[my bold]

Breast cancer checks missing lots of at risk younger women, says study - BBC News

A radiographer provides assistance to a patient undergoing a mammogram in a modern medical facility

Breast cancer checks missing lots of at risk younger women, says study

Up to 95% of younger women who are at higher risk of developing breast cancer are being missed by current NHS checks, researchers warn.

https://www.bbc.co.uk/news/articles/ckgv652r625o

OP posts:
Original poster
AngleofRepose · 04/08/2026 12:01

There doesn't seem to be any mention in the article of risks due to mammography. The only note of caution was this paragraph:

"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."

I suppose mammography could "buried" within this statement, but I'd like to read more about this before I dismiss it due to mammography "risks."

I was one of those under 40s who could have benefited from earlier detection and better understanding of genetics and family history. It was assumed that, because I was young, my risk was negligible, and therefore didn't get a referral straight away. I had to fight for my referral.

If NICE criteria are failing women, I think it's right to consider other options.

OP posts:
mids2019 · 04/08/2026 11:46

I think you have to think about absolute numbers developing breast cancer under 50 especially with younger age groups and balance this against the risk of secondary cancers on a population level of mammography etc. as discussed in your article. I think there is a parallel with prostate cancer detection in younger men where the risk of false positives increases with younger age with the consequent invasive further testing and the risk of unneeded treatment.

I don't think Oncologists are malign in not extending breast cancer screening of any type to younger cohorts but statistical decisions need to be made pragmatically. We can't screen everyone for every cancer from the age of 20 upwards even though theoretically there is a risk (albeit small).

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