Progress, however, is continuous and all guidance needs updating. We welcome the opportunity that the National Institute for Clinical Excellence (NICE) has provided to review the original breast guidance in areas where science or practice has moved on. We have not rewritten the whole document since most of the original content remains valid, service guidance being less vulnerable to small clinical changes than clinical guidelines. The context of this updated guidance is very different from that of six years ago. Mortality rates from breast cancer in women under the age of 70 have shown a sharp and sustained fall, well documented by Peto et al 4 and Purushotham et al 5
