Rapid diagnosis: Concern over the high number of women attending a weekly clinic for breast cancer checks, who had a strong family history of cancer, has led to the establishment of a family assessment clinic at Tallaght hospital.
The clinic, which was opened yesterday by the Tánaiste and Minister for Health Mary Harney, has been granted funding for a specialist nurse for three years from the Adelaide Hospital Society. It is already assessing three patients a week and will shortly install technology to map histories of cancer in the families of those referred.
James Geraghty, consultant breast surgeon at Tallaght Hospital, has been compiling figures from his weekly rapid diagnostic clinic for the past two years and has more than 100 patients who, he said, might have a higher risk of developing breast cancer on the basis of family history.
Mr Geraghty estimates about 15 per cent of cancers are genetic, however, some 20 per cent can be described as "familial", where there is a family history of the disease but, as yet, no established genetic link.
The concern over the number of women presenting with a strong family history, particularly young women, led to the establishment of this assessment clinic, which is not a symptomatic clinic but which will refer patients for management of their risk where necessary.
"We are quite amazed at the high number of strong family history patients that we have. We have just started this clinic in the last month and we have identified patients from our symptomatic breast clinic, the normal one-stop rapid diagnostic clinic, who were referred by their GP for a number of different reasons.
"We have patients whose family history is so strong that their lifetime risk might be a 50 to 80 per cent chance of breast cancer," Mr Geraghty said.
He estimated that based on current cancer diagnoses, up to 300 women each year may have a familial background of cancer. "So you can imagine the number of families that might be involved," he said.
Patients referred to the family assessment clinic include Maria (50) from Co Wicklow (not the patient's real name) who was referred to the clinic in February after her doctor found a lump.
She is undergoing the complex process of assessment, which involves consultations with the specialist nurse, and research, with her written consent, into her family medical history.
"My sister died in 2000 of secondary breast cancer and I have a history of cancer going back to my great grandfather. So I was worried, quite considerably. But they've been very good here. They've checked it out. They did the fine needle test, mammogram, scan, biopsy on it and lucky enough for me it isn't cancer, it's just a lumpy breast, not a lump in the breast," she said.
Maria's sister was diagnosed with breast cancer at 39 and died aged 42. An aunt and a cousin in Australia are undergoing treatment. Her maternal grandmother had breast cancer and a maternal aunt had ovarian cancer, which is also a risk factor for breast cancer.
Maria will return in July for a consultation with Mr Geraghty and the clinic's specialist nurse, Victoria Lee, who has a higher diploma in oncology.
As with other patients, she will be categorised as low risk, moderate risk or high risk based on the full family history and her risk will be managed depending on the outcome. Mr Geraghty said guidelines had been drawn up for GPs to help them determine who should be referred.
"In the majority of cases, I would hope that patients will be reassured by their GP, on the basis of their family history and the guidelines that we send out, that they don't need to be referred." But where someone is referred to the family assessment clinic, Mr Geraghty said it was important to emphasise that in the majority of cases "we will be able to reassure women that their family history is not significant and that they're in the low-risk category". Victoria Lee said the main aim of the clinic was to identify "the very specific population of families to promote early diagnosis".
Ms Lee said: "These women need screening and they need education and they need other management options. A lot of them know their family history and they are concerned and quite frustrated that they are going to the GP with a family history and GPs are getting frustrated because there's nowhere to send these women.
"I can understand their frustration. I can hear the sense of relief when I speak to them over the phone. It's just amazing the sense of relief they feel that finally this is being looked after. We have to empower the patients to make informed decisions themselves.
"Where we are screening them on a yearly basis, they still need to take that management on in between."
She acknowledged that breast cancer was every woman's fear, but said: "It's so manageable when it's caught early and we need to educate women about how important early detection is. It's a treatable condition when it's caught on time."