(Press-News.org) UNDER STRICT EMBARGO UNTIL 4PM (UK TIME) 11 AM (US EASTERN TIME) ON THURSDAY 24 JULY 2025
When should preventive mastectomy be offered for women at higher risk of breast cancer
Peer reviewed | Simulation/ modelling
More women at higher risk of breast cancer should be offered a mastectomy, according to researchers at Queen Mary and London School of Hygiene and Tropical Medicine. A new analysis has found that the surgical technique was a cost-effective way of reducing the likelihood of developing breast cancer compared to breast screening and medication. Current guidelines on who is offered mastectomy may need to be revised to reflect these new findings.
Clinicians currently use personalised risk prediction models which combine genetic and other data to identify those women who are at a higher risk of developing breast cancer (BC). Subsequent treatment options – including mammograms, MRI screening, surgery, and medication – are then offered dependent on each woman’s level of risk.
Risk reducing mastectomy (RRM) is recommended for women at high risk, but in practice this surgery is only clinically offered to those carrying faults (called pathogenic variants) in genes that are known to increase the likelihood they will develop the disease (BRCA1/ BRCA2/ PALB2 PV).
Professor Ranjit Manchanda from Queen Mary University of London, Dr Rosa Legood from London School of Hygiene and Tropical Medicine, along with colleagues from Manchester University and Peking University created a new economic evaluation model to accurately predict the level of risk that would make RRM a more cost-effective treatment.
For their model, researchers used guidelines from the National Institute for Health and Care Excellence (NICE) to determine whether a treatment is considered cost-effective. Their model showed that mastectomy was a cost-effective treatment for women aged 30 or above who have a lifetime breast cancer risk greater than or equal to 35%. Offering RRM to women in this cohort could potentially prevent 6,500 of the 58,500 cases of breast cancer that are diagnosed every year in the UK.
Professor Manchanda, Professor of Gynaecological Oncology at Queen Mary and Consultant Gynaecological Oncologist, said: “We for the first time define the risk at which we should offer RRM. Our results could have significant clinical implications to expand access to mastectomy beyond those patients with known genetic susceptibility in high penetrance genes- BRCA1/ BRCA2/ PALB2 - who are traditionally offered this. This could potentially prevent can potentially prevent ~6500 breast cancer cases annually in UK women. We recommend that more research is carried out to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group”..
Dr Legood, Associate Professor in health economics at the London School of Hygiene & Tropical Medicine, said: “Undergoing RRM is cost-effective for women 30-55years with a lifetime breast cancer risk of 35% or more. These results can support additional management options for personalized breast cancer risk prediction enabling more women at increased risk to access prevention.”
Dr Vineeth Rajkumar, Head of Research at Rosetrees, said: "Rosetrees is delighted to fund this truly groundbreaking research that could have a positive impact on women worldwide.”
The researchers used data from women aged between 30 and 60 with varying lifetime breast cancer risks between 17% and 50%, and who were either undergoing RRM or receiving screening with medical prevention according to currently used predictive models.
NICE deems a treatment cost effective if it typically brings one additional year of health for no more than £20,000-£30,000 per patient (known as the ‘willingness to pay’ threshold, or WTP). The researchers’ model used a threshold of £30,000/Quality Adjusted Life Year.
ENDS
NOTES TO EDITORS
Contact
Honey Lucas
Faculty Communications Officer – Medicine and Dentistry
Queen Mary University of London
Email: h.lucas@qmul.ac.uk or press@qmul.ac.uk
Paper details:
Xia Wei et al, ‘Defining lifetime risk thresholds for breast cancer surgical prevention: cost-effectiveness analysis’. JAMA Oncology.
DOI: TBC
Available after publication at: TBC
Under strict embargo until 4PM (UK time) 11 AM (US Eastern time) on Thursday 24 July 2025.
A copy of the paper is available upon request.
Conflicts of interest:
Dr Manchanda reports receiving grants from Yorkshire Cancer Research, GSK, NHS England, and the NHS Innovation Accelerator; receiving speaking fees from GSK; and receiving personal fees for serving on the advisory boards for EGL and AstraZeneca outside the submitted work. No other disclosures were reported.
Funded by:
This study was supported by grants from the Rosetrees Trust, Barts Charity, and China Medical Board (No. 19-336). DGE is supported by the Manchester National Institute for Health Research Manchester Biomedical Research Centre (NIHR203308).
About Queen Mary
www.qmul.ac.uk
At Queen Mary University of London, we believe that a diversity of ideas helps us achieve the previously unthinkable.
Throughout our history, we’ve fostered social justice and improved lives through academic excellence. And we continue to live and breathe this spirit today, not because it’s simply ‘the right thing to do’ but for what it helps us achieve and the intellectual brilliance it delivers.
Our reformer heritage informs our conviction that great ideas can and should come from anywhere. It’s an approach that has brought results across the globe, from the communities of east London to the favelas of Rio de Janeiro.
We continue to embrace diversity of thought and opinion in everything we do, in the belief that when views collide, disciplines interact, and perspectives intersect, truly original thought takes form.
About The London School of Hygiene & Tropical Medicine (LSHTM)
The London School of Hygiene & Tropical Medicine (LSHTM) is one of the world’s leading public health universities. Its 3,500 staff and 4,700 students are working together to help create a more healthy, sustainable and equitable world for everyone. With main sites in London, The Gambia and Uganda, and an annual research income of £190 million, it is uniquely placed to make a tangible impact on people’s lives through highly-rated research, postgraduate education and global networks. LSHTM’s mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.
Follow us on social media @LSHTM
www.lshtm.ac.uk
END
When should preventive mastectomy be offered for women at higher risk of breast cancer
2025-07-24
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