Intended for healthcare professionals

Rapid response to:


NICE recommends controlled intrabeam use for breast cancer after three year delay

BMJ 2017; 356 doi: (Published 10 February 2017) Cite this as: BMJ 2017;356:j725

Rapid Response:

Re: NICE recommends controlled intrabeam use for breast cancer after three year delay:

We see from this report [1] that there has been a delay since July 2014, when NICE `published virtually identical draft guidance`, to recommend controlled intrabeam use for people with early breast cancer. We are advised that this delay was due to comments received from some professional groups.

It is an incontrovertible fact that, however thorough, robust and reliable data may be (as it was in this case), uncertainty will always remain. [2] But the value and satisfaction that patients gain from being allowed to make an informed choice between (in this case, all available radiotherapy treatment options) according to their circumstances and preferences, is an equally important factor that needs to be properly weighed in the balance when regulators are judging the proper time to make their recommendations. The ethical dimensions of delay, both by those charged with providing official guidance, and of `some professional groups` whose comments, [1] `delayed release of the final guidance`, need to be considered in the light of its considerable detrimental effects on many breast cancer patients, and on our NHS.

This long delay has caused many UK patients to be denied choice of radiotherapy treatment. It has also caused huge wastage of precious NHS resources and time. How many treatment hours could have been saved? How much NHS money has been unnecessarily spent? How many road miles have been unnecessarily travelled? How many carbon emissions could have been avoided? How many hours of work have been avoidably lost to radiotherapy treatment? [3]

[1] Jacqui Wise. NICE recommends controlled intrabeam use for breast cancer after three year delay. BMJ 2017:356:j725

[2] Evans I, Thornton H, Chalmers I, Glasziou P. Testing treatments: better research for better healthcare – Second Edition. Pinter and Martin, London. 2011. ISBN 978-1-905177-48-6 Free download from Chapter 4

[3] Coombs NJ, Coombs JM, Vaidya UJ, et al. Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open 2016;6:e010703.doi:10.1136/bmjopen-2015-010703

Competing interests: Member of the Data Monitoring Committee of the TARGIT-A trial

14 February 2017
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences,
University of Leicester
"Saionara" 31 Regent Street, Rowhedge, Colchester, CO5 7EA