Comparison of NICE criteria with the BOADICEA multifactorial risk model to guide breast cancer risk assessment and referral amongst women under age 50 within primary care

BACKGROUND: The National Institute for Health and Care Excellence (NICE) recommends that women at above-population-level risk of breast cancer (BC) are offered enhanced screening and risk-reducing interventions. Identification of these women largely relies on referral through primary care based on family history criteria. METHODS: We compared the performance of the NICE criteria with versions of the BOADICEA multifactorial risk model in identifying women who developed BC within 10 years. Analyses included 1258 women aged under 50 years with family history, reproductive, lifestyle and polygenic risk data recruited to the Generations Study between 2004 and 2011 (392 BC cases), weighted to represent the UK population with respect to age and family history of BC. RESULTS: NICE criteria identified 4.4% of women who developed BC within 10 years amongst 1.4% of women who met referral criteria. The full BOADICEA model identified up to 35% of women who developed BC, but with lower specificity and 26.5% of women meeting referral criteria. CONCLUSIONS: NICE family history-based criteria applied to women under 50 miss most BCs occurring within 10 years. Multifactorial risk assessment in primary care could substantially improve the identification of women at risk who could be offered interventions before being invited to population-based screening.