Women could be offered NHS mammograms from the age of 40 under “targeted” checks being considered by health chiefs.
Prof Sir Mike Richards, who advises the Government as chairman of the UK national screening committee, said there was a case for earlier checks than under the current programme.
At present, the NHS offers mammograms every three years between the ages of 50 and 70. The oncologist said there were “far more” people who might benefit and the programme could be extended to find more cases earlier.
Targeted checks, offered at a younger age and on a more regular basis, are already offered to women with the “Jolie” gene, which vastly increases their risk of breast and ovarian disease.
Angelina Jolie, the actress, had surgery to remove her breasts because she had inherited a mutated BRCA1 gene.
However, Sir Mike said screening chiefs were considering rolling the programme out so that women with a family history of breast cancer, and those with other risk factors, could have their first mammograms far younger.
‘Concern’ at-risk women not identified
Local health services are meant to identify those women at greatest risk, but Sir Mike said “there is a concern” that this is not happening enough. He said his screening committee was now examining whether to introduce a “national targeted risk” programme.
Sir Mike said there was a case for earlier checks, particularly for women with breast cancer in the family.
Currently, targeted checks focus on those with two specific genes BRCA1 and BRCA2, which increase the risks of cancer by up to 90 per cent.
However, other women without these genes but a family history of breast cancer may also be at increased risk, while other genes, and factors such as dense breasts, also increase risk.
“There are people who say if you’ve got a family history maybe you should have a one-off mammogram at 40. I’m not advocating one approach but there are a lots of questions like that that need to be answered,” he said. Sir Mike added that, while targeted screening is only offered to a “tiny” number of women at greatest risk, there were “far more” who might benefit from earlier checks.
He said: “There are far more women in between standard risk and very high risk. Women who’ve got a family history but it’s not the BRCA 1 or 2 are probably the largest group. Also we know women with very dense breasts on mammography are both at higher risk of cancer but they also more difficult for mammography to pick it up because of the density.
“And there are other genes, which are nothing like BRCA1 and BRCA2 but which combined together give us polygenic risk scores [showing an increased risk]. Can we, for an individual woman, say: ‘Because you’ve got dense breasts and you’ve got a family history we think you should start younger and have screening annually?’ ”
National scheme
Mammograms at the age of 40 might be required to establish some of the risk factors, such as breast density, he said.
While local services attempt to identify those most at risk, based on guidance from the National Institute of Health and Care Excellence, he said there was “a big programme of work” ahead to consider the introduction of a national scheme.
The committee is also considering rolling out prostate cancer screening, after research suggested the benefits may outweigh the risks.
Currently, there is no national programme inviting men without symptoms to undergo checks, although those over 50 can request them on the NHS.
Sir Mike said a targeted approach – with prostate-specific antigen tests offered to those thought to be at highest risk, which could include those with a family history of the disease – was one of the ideas under consideration.
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