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Breast cancer patients could be offered hormone therapy for a decade, says Nice

Extended hormonal therapy could reduce the risk of breast cancer returning in some patients, Nice said.

Some breast cancer patients could be offered hormone therapy for a decade under new NHS guidelines.

And all women who have a mastectomy due to breast cancer should be offered immediate breast reconstruction, under draft National Institute for Health and Care Excellence guidelines.

Meanwhile, some women should be offered bisphosphonates – a cheap bone-strengthening drug – which has been shown to improve disease-free survival and overall survival, Nice said.

The draft updated guideline on early and localised advanced breast cancer calls for extended hormonal therapy for some women after they have taken tamoxifen in order to reduce the risk of their breast cancer coming back.

The new recommendation is for post-menopausal women with ER-positive invasive breast cancer who have already been taking the drug tamoxifen for two to five years.

Nice said that research shows that switching to an aromatase inhibitor after taking tamoxifen for five years can improve the time a woman has without the disease returning.

This should be offered for no more than an additional five years, the guideline adds.

But lengthening the time on hormone therapy can lead to an increased risk of endometrial cancer and osteoporosis, so the experts said that women should weigh the risks and benefits with their doctor before extending hormone therapy.

Meanwhile, a panel of experts at Nice said that many breast cancer centres do not routinely offer immediate breast reconstruction to all women.

They said that the benefits of immediate reconstruction compared with delayed reconstruction include: aesthetic satisfaction, improved health-related quality of life, lower rates of complications and a reduced need for further surgery.

Previous guidance suggested that women should not be offered it if adjuvant therapy – such as chemotherapy or radiotherapy – or another comorbidity “preclude this option”.

But the new guidance states that all women should be offered to all women – including those who may need radiotherapy.

Breast Cancer Now estimates that of the 17,200 women who undergo a mastectomy following a breast cancer diagnosis each year in the UK – over 3,500 of these patients opt to have immediate reconstruction.

Professor Mark Baker, director of the centre for guidelines at Nice, said: “Although breast cancer survival rates have improved over recent decades, it remains the leading cause of death in women aged 35-49.

“Since the publication of Nice’s original guideline in 2009, there have been a number of advances in the way early breast cancer is managed and these are reflected in this updated guideline.

“This will help healthcare professionals to provide consistent, high quality care for people with early breast cancer and ensure equal access to the most appropriate treatments, no matter where people live in England and Wales.”

Commenting on the guideline, Baroness Delyth Morgan, chief executive at the charity Breast Cancer Now, said: “If now funded and implemented across the country, these steps could save and improve thousands more women’s lives.”

Samia al Qadhi, chief executive of Breast Cancer Care, added: “It is exciting to finally see the wheels in motion for this long overdue guidance.

“Nine years after the last update, these treatment recommendations will offer much needed clarity for women navigating the uncharted waters of a breast cancer diagnosis.”

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