IMPROVED access to a cancer genetics service could dramatically reduce mortality in Irish women with an inherited predisposition to breast and ovarian cancer, according to an expert on the disease.
Dr Noah Kauff from the renowned Memorial Sloan-Kettering Cancer Center in New York said women with a genetic risk of ovarian cancer have a dramatically increased risk of getting the disease, and unfortunately most ovarian cancers are diagnosed at a late stage when they are not curable.
However, access to a genetics counselling and testing service and timely intervention – whether through intensive screening, chemo-preventative medication or surgery – could greatly reduce their risk of getting and dying from ovarian cancer, he said.
Dr David Gallagher, who trained in medical oncology and genetics with Dr Kauff at the Memorial Sloan-Kettering, recently set up the first Irish cancer genetics clinic integrated into a designated cancer centre at the Mater Private in Dublin. More than 100 patients have already attended the service.
He said: “The national cancer institutes in the US, like the National Cancer Control Plan in Ireland, recognises the need for genetic services to be integrated into cancer centres as a central component of a national cancer care strategy. There is a real need to develop this service in this country where access is currently limited and waiting lists are long.”
A patient attending the cancer genetics clinic at the Mater Private has a family history taken first and if a red flag is raised that he/she may have a genetic predisposition to a particular type of cancer, a genetic test can be carried out.
If this test shows the patient has a specific gene that predisposes them to a certain type of cancer, they can be put into a special screening programme so it is detected at an early, more curable stage, or can proceed with a cancer-prevention programme.
Dr Gallagher explained that in hereditary ovarian and breast cancer, having ovarian surgery pre-menopause can also dramatically reduce the risk of breast cancer.
“Women with an inherited predisposition are at a drastically increased risk of cancer. One in 50 women in the general population will develop breast cancer by the time they are 50, but in women with an inherited predisposition, as many as one in three will develop breast cancer as early as 50 and even as early as their mid-20s.
“In ovarian cancer, instead of one in 70 women in the general population, the lifetime risk can be as high as one in two, which is why some of the interventions offered are very different for this population.”
He points out that for women with the BCRA1 or 2 breast cancer mutation, mammography misses 70-80 per cent of cancers, which is why a very different approach has to be taken to their care. This can involve aggressive surveillance, risk-reducing surgery or chemo-preventative medications.
Dr Kauff was in Ireland last week to speak at a public meeting on advances in ovarian cancer at the Mater University Hospital in Dublin.
