Thousands of women with a family history of breast cancer are being given access to medicines to help prevent the disease under ground-breaking new guidance from NHS cost regulator the National Institute for Health and Care Excellence.
An update to NICE's familial breast cancer clinical guideline says hormone therapy with tamoxifen or raloxifene can now be prescribed for at-risk women in England and Wales for up to five years to help cut their risk of getting the disease.
The move marks a massive shift in the breast cancer care landscape, as until now the only option for women with a family history of the disease was annual screening or mastectomy.
"Although neither drug is licensed as a preventative treatment in the UK, clinical evidence shows they are an effective option for many women and could be preferable to surgery," said Professor Mark Baker, Director of the Centre for Clinical Practice at NICE.
However, while both drugs reduce the risk they do come with side effects, and these carry a different weight when being considered in a preventative strategy.
In the adjuvant setting, tamoxifen can cause blood clots and cancer of the lining of the womb, while raloxifene can increase the risk of osteoporosis and bone fracture and can sometime cause intolerable muscle and joint aches and pains.
Nevertheless, Caitlin Palframan, Assistant Head of Policy at Breakthrough Breast Cancer, said the guidelines are "a game changer" in breast cancer prevention.
"Our strongest tool in the fight against breast cancer is prevention, and these new guidelines are a fantastic leap forward in the way we prevent breast cancer developing in those at highest risk".
However, she also noted that the next challenge will be "ensuring the NHS is equipped to deliver on the promise of these recommendations; more screening, genetic testing and better preventative options for those few people at highest risk".
Sanofi's Zaltrap rejected
Elsewhere, the Institute has rejected Sanofi's Zaltrap (aflibercept) as a second-line treatment for colorectal cancer.
The move came after its independent appraisal committee concluded that the most "plausible" cost per Quality Adjusted Life Year (QALY) ranged from £62,900 to £66,500, thereby falling outside the range of what is normally considered value for money.
Explaining the decision, NICE chief executive Andrew Dillon said that while the committee considered aflibercept to be "a clinically effective treatment, it could not be considered a cost-effective use of NHS".
In May Zaltrap, however, was added to the Cancer Drugs Fund, giving patients a chance of having their treatment funded through that channel.