Breast cancer patients in Scotland face a postcode lottery that could limit access to two newly approved NHS treatments.

The Scottish Medicines Consortium has approved Elacestrant and Capivasertib, which could be life-extending for some people with metastatic breast cancer.

Eligibility depends on genetic testing to confirm gene mutations before treatment can be prescribed, but the necessary testing is not yet available through the NHS in Scotland.

The testing is available to patients in England and to those able to pay for it privately.

Claire O’Donnell, who was diagnosed with metastatic breast cancer at 37, has raised concerns about the difference in access.

Ten years after her diagnosis, O’Donnell is receiving a treatment that works for her but does not know when it may stop being effective.

She said: “I know how lucky I am. It’s certainly not been easy but I’m incredibly lucky and incredibly privileged to be in that position.

“I’ve watched a lot of my friends die, and a lot of the circumstances has been about not being able to access a drug or getting the drug too late or being too poorly by the time the drug becomes available to them. It makes me angry, and it makes me sad.”

O’Donnell, who has been supported by secondary breast cancer charity Make 2nds Count, is frustrated by the gap in care for patients in Scotland.

She said: “These drug are a lifeline to people. It makes all the difference, and it only takes one drug to be your drug that you know can give you six months a year, two years, five years. It’s almost like they’ve given you a bit of good news, but they’ve also put a little bit of a criteria on it that you know they dangle the carrot in front of you.”

David Cameron, professor of oncology at Edinburgh University and chair of trustees for Make 2nds Count, said the system needed improving to better support patients.

He said: “It’s a frustration for many of us in the clinic because for a long time we’ve been saying as we move into an era of medicines, not just cancer medicines, but medicines that are increasingly driven by special tests, we need a system which absolutely locks the two things together.

“There has been progress in that direction, but they’re not locked together. this comes down to the way the NHS is in a sense fragmented internally.”

Health secretary Angela Constance said: “I welcome the acceptance of Elacestrant, known as Korserdu, for treatment of post-menopausal women, and men, with a certain type of advanced breast cancer.

“We work closely with the independent SMC and the NHS in Scotland to improve access to new medicines, helping to expand the range of treatment options available.

“We are aware that a genomic test is needed in order to access this therapy, and we are working in collaboration with the NHS and industry partners to secure access to this as soon as possible.”

A urine and vaginal fluid test could help rule out womb cancer in women with postmenopausal bleeding, potentially reducing invasive checks.

In a study of 1,864 women with postmenopausal bleeding, the test identified 80 of 99 womb cancers and correctly gave a negative result for 93 per cent of women without the disease.

Researchers said the test was not accurate enough to rule out cancer on its own, but could help fast-track women at the highest risk for urgent investigation while reducing immediate invasive testing for those at lower risk.

Professor Emma Davidson, of the University of Manchester and Manchester University NHS Foundation Trust, said: “Bleeding after the menopause is understandably alarming for women because it can be a sign of cancer, but the vast majority of those investigated will not have the disease.

“At the moment, many women face invasive, uncomfortable tests that can be stressful as well as costly for health services before cancer can be ruled out.

“Our study shows that a simple test using urine and vaginal samples could help identify the women most likely to have cancer while safely reassuring many others much earlier in the diagnostic pathway.

“If further studies confirm these findings in routine practice, this approach has the potential to transform care for thousands of women every year.”

Developed at the University of Manchester and Manchester University NHS Foundation Trust, the test examines cells collected from urine and vaginal fluid samples.

Postmenopausal bleeding currently triggers an urgent cancer referral, although only about 5 to 10 per cent of women who report it have an underlying cancer.

Current investigations include an internal ultrasound scan, a biopsy of the womb lining and hysteroscopy, in which a camera is passed into the womb.

Women taking part in the study attended seven hospitals in north-west England and provided urine and vaginal fluid samples before undergoing their routine tests.

Five per cent of participants, 99 of 1,864 women, were diagnosed with womb cancer through biopsy or surgery.

Cytologists assessed the samples without knowing the women’s diagnoses.

Researchers said the test could be used to triage women suspected of having womb cancer, with lower-risk patients monitored through repeat sampling or given a full assessment if symptoms continued.

They cautioned that the samples were assessed by highly trained specialist cytologists, so it is not yet known whether the same accuracy could be achieved in other settings.

The test has also not been studied in women without symptoms.

Higher BMI at 20 was linked to a lower risk of post-menopausal breast cancer in an analysis of more than 33,000 women.

Lower breast density later in life may partly explain the link between higher body mass index, or BMI, in early adulthood and lower breast cancer risk after menopause.

The findings could help explain why higher body weight in childhood, adolescence and early adulthood appears linked to lower long-term risk, while being overweight in middle age is associated with increased breast cancer risk.

First author Dr Benoit Jauniaux, a surgical trainee in the North-West Deanery, said: “Researchers in previous studies have observed that women with a higher BMI in childhood or their early adulthood appear to have a lower risk of breast cancer after the menopause, but we have not fully understood why.

“This study suggests that downstream changes to breast density may explain a large part of this effect.”

The study was published in the British Journal of Cancer on 17 September 2026 and was supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC): Manchester.

Researchers at The University of Manchester and Manchester University NHS Foundation Trust followed 33,816 women taking part in the UK Predicting Risk of Cancer at Screening (PROCAS) programme for more than a decade.

They recorded 1,261 cases of post-menopausal breast cancer and compared women’s self-reported BMI at age 20 with breast density measurements from routine mammograms.

Breast density refers to the amount of fibrous and glandular tissue compared with fatty tissue in the breast. Women with denser breasts are known to have a higher risk of breast cancer.

Women with a higher BMI at age 20 generally had lower percentage breast density later in life and were less likely to develop post-menopausal breast cancer.

For every five-point increase in BMI at age 20, the risk of developing post-menopausal breast cancer fell by around 15 per cent. Further analysis suggested lower breast density may account for almost 60 per cent of this effect.

Researchers believe the timing of body weight gains may be crucial because women’s breasts are still developing during adolescence and early adulthood, potentially leading to long-term changes in tissue structure.

The study also found that different measures of breast density may reflect different biological pathways linked to breast cancer risk.

One measure, estimating the percentage of dense tissue within the breast, appeared to capture some of the lasting effects associated with higher body weight in early adulthood. Another measure, based on the total volume of glandular tissue, appeared to be more strongly influenced by body weight later in life.

Senior author Professor Andrew Renehan is professor of cancer studies and surgery at The University of Manchester and programme co-lead in the Cancer Prevention and Early Detection Theme at the NIHR BRC: Manchester/

The researcher said: “These findings do not suggest that gaining weight is protective.

“What they offer is further insight into how breast tissue and consequent breast cancer risk may be shaped across a woman’s lifetime, and we want to understand these mechanisms further.

“Maintaining a healthy weight remains important, because excess weight in later adulthood is linked to a higher risk of breast cancer and many other serious diseases.

“But this study adds to growing evidence that exposures during early life can have lasting effects on health decades later.”