We reporters sharpen our scalpels when we hear the name NICE. Ready to attack it for turning down some cancer drug that extends patients' lives but is too expensive for the NHS.
So it's a bit unusual to be reporting a recommendation from NICE that is being welcomed by almost everyone as genuine good news.
Today NICE has recommended that women at high risk of developing breast cancer should be offered a five-year course of drugs to prevent the disease developing. "A pill to prevent cancer" shouted the headlines. Well not quite that simple, but in principle, yes.
Great news for thousands of women. But not all of those who get breast cancer.
50, 000 women (and men) are diagnosed with breast cancer every year. About 10,000 of those have a family history of the disease and have inherited a gene linked to the disease.
that meant she had an 87 per cent risk of breast cancer. She decided to have her breasts and ovaries removed surgically to reduce that risk to an 7 per cent (about average).Until now surgery has been one of only two options available to women who inherited this gene (or its sister BRCA2).
The other was to have a mammogram every year to spot the almost inevitable cancer early. Most women I've spoken to in this position opt for surgery and "peace of mind".
Now these's a third option - a five-year course of drugs to stop the cancer emerging - tamoxifen or raloxifene. The first of these reduces the risk of breast cancer by 30-40 per. cent. In the UK neither is licensed as a preventive treatment (they are in the US) but have been used to stop breast cancer recurring for many years.
And NICE says they are cheap enough for the NHS - Tamoxifen costs £125 for a five-year course, much less than around £10 000 for surgery. Of course, they do have side-effects - they're a bit like the menopause (hot flushes and so on). But these usually wear off after 6 months. And surgery is not without risks either.
The point is that women who find out they are at high risk of breast cancer now have another choice. And, even more important, those choices can be tailored for each individual.
For example, by analysing your genes scientists can now put a number on your chances of developing breast cancer. If your chance is 10 per cent, you may think that's not high enough to justify either surgery or a course of drugs. If it's 80 per cent, you would probably want to do something about it.
NICE recommends women at 30 per cent risk should be offered the drug treatment. The final decision between surgery, drugs, or annual checks is of course up to the patient. But women now have a wider choice and more facts to help them make probably the most difficult decision of their lives.