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Breast cancer: London IDEAS programme
The main themes of the
programme are:
- Equal access to care. The background of patients
attending cancer genetics and clinical genetics clinics is being
measured. Are the majority of people asking for an assessment
of their family history from a particular "social class"? Are
people from other classes not coming to the clinics?
- Chemotherapy trial for genetic breast cancer.
It is thought that breast cancer patients who have a breast cancer
gene might respond better to a particular cancer drug (platinum)
than to others. We supported the development of the chemotherapy
trial and it has now received full funding. It is the first clinical
trial of chemotherapy linked to the genetics of the patient ("pharmacogenetics").
- Teleconsultation for cancer genetics. There
is a national shortage of health professionals trained in clinical
cancer genetics. In order to provide consultations efficiently
across the country, we have piloted a video link system in Southend
General hospital. The patient and a trained nurse or genetics
counsellor sit in Southend at the hospital, and the consultant
and other medical staff are in the "teleconferencing" room in
London. So far patients have been very positive about this method
of talking with their specialist and the system is now set up
in four centres in Essex.
- Improving patient information in cancer genetics.
It is essential that patients and their families receive accurate
and up-to-date information about cancer risk and possible treatments.
The NE Thames Cancer Genetics Service is working with CancerBACUP
to provide this information. As new information becomes available,
it will be posted on the CancerBACUP
website.
- Services for "carriers". People who
have a change in a gene that predisposes them to breast cancer
(such as BRCA1 or BRCA2) but who have not actually had cancer
need to be supported and monitored. Services are well established
for cancer patients, but the idea of a "carrier clinic"
is relatively new. We are measuring how well the carrier clinic
at the Royal Marsden Hospital in London meets the needs of the
people attending it, with a view to helping the NHS set up similar
clinics across the country.
- Risk assessment by computer. People can be
classified into high, medium or low risk for breast cancer depending
on things such as whether their relatives have had breast (or
some other types of) cancer and what age they were when it was
diagnosed. A high risk classification will lead to a referral
to a specialist genetics clinic, whereas a low risk classification
means that the GP can monitor the situation without referring
to a hospital. To help GPs make the classification, they need
to ask their patient quite a few questions. In this pilot study,
we have developed computer software that allows people to fill
in this information on a screen while they are in the waiting
room. A grant application for a full size study to measure how
well this works has been submitted.
Contact
The London IDEAS leads
on these projects are Dr James Mackay (University College London)
and Dr Ros Eeles (Royal Marsden Hospital). For further information,
contact Dr Amy Hunter at
the London IDEAS office.
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