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Abu Dhabi, UAEFriday 21 September 2018

Doctors call for targeted breast screening so women have chance of family after cancer treatment

Oncologists at a cancer summit in Madrid say health insurers should cover cost of simple blood tests that would help identify cancer risk in women who are genetically predisposed

Women are advised not to start a family until at least a year after chemotherapy due to toxins in the treatment. Silvia Razgova / The National
Women are advised not to start a family until at least a year after chemotherapy due to toxins in the treatment. Silvia Razgova / The National

A more targeted approach to breast screening could help more women start a family through earlier diagnoses and use of the most effective treatment.

Chemotherapy and hormone therapy can have devastating physical effects, despite their success in killing off cancer. Women are advised not to start a family until at least a year after chemotherapy has ended, and hormone therapy can continue for more than a decade.

A simple blood test for the BRCA 1 and 2 genes, a known precursor for breast cancer, could help treat women 10 years before they develop the condition.

It should be paid for by health insurers, said one of the UAE’s leading oncologists, to help reduce the cost of treatment and make it more effective.

Dr Falah Al Khatib, a consultant clinical oncologist at City Hospital, Dubai, speaking at the European Association for Cancer Research in Madrid, said: “Generally, we see people at a younger age than elsewhere in the world.

“In the West, they start screening at age 50 but cancer can take between 10 to 15 years to develop.

“If 40 per cent of your population is under 45, as in the UAE, is screening effective?

“We have better diagnostic machines now, and can check a select population with a family history of cancer we know are more at risk.

“These are the people we should be trying to screen for the BRCA 1 or 2 gene 10 years or so before their relatives had breast cancer.”

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A BRCA screen is a simple blood test, costing about Dh6,000.

Although not practical for every woman, Dr Al Khatib recommends those with a family history should be prioritised as early detection could save thousands of dirhams for each case of breast cancer.

Surgery can cost between Dh50,000 to Dh60,000, while radiotherapy costs about Dh100,000 and an average chemotherapy course can amount to Dh400,000. If the woman needs other hormonal treatments, the costs can exceed Dh1 million.

“We can then go on to detect their other family members through a test,” said Dr Al Khatib.

“It would be the most effective option to reduce the cost of cancer treatments.

“Surgery would give a 100 per cent protection but there are other drug treatments that can offer a 90 per cent protection rate. Most women would opt for a mastectomy.”

Genetic testing is crucial in determining the outcomes of young women found to have breast cancer, and could help them to have a family once recovered.

Fertility and breast cancer treatments were discussed by other cancer specialists at the summit. The experts discussed recent research showing that gene expression tests can be done to help determine appropriate treatment.

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Evidence showed a greater risk of mutations in the BRCA 1 and 2 genes in younger women.

Doctors said the choice of drugs used to fight breast cancer was crucial in determining if a woman would later be able to have children, as some are markedly more toxic than others and can damage fertility. And the age of the woman should determine whether she is referred for genetic testing.

“Giving chemotherapy or not in endocrine-responsive women is one of the most intriguing and debated decisions in oncology,” said Olivia Pagani, a Swiss cancer specialist.

“A number of factors must be considered, such as patient and tumour characteristics, so, where available, genetic expression tests should be done.”

Gene expression is a process that extracts unique genetic information from a patient to help give doctors data on which to base a decision on the most suitable form of treatment.

According to the National Cancer Institute of Spain, about 12 per cent of women in the general population will develop breast cancer at some point in their lives.

Most recent estimates suggest 55 to 65 per cent of women who inherit a harmful BRCA 1 mutation and about 45 per cent of women who inherit a harmful BRCA 2 mutation will develop breast cancer by age 70.

They are also more susceptible to ovarian cancer in their lifetime.

Suzette Delalogue, a French oncologist, said a woman under the age of 45 with a family history of breast cancer should be referred to a geneticist.

“Age is an indication on whether to refer a patient for genetic testing or not, not only for BRCA 1 or 2 but also for other genetic indicators,” she said.

“We know the prevalence of genetic mutations is higher in younger women, so we can use this to determine the urgency of referral to a geneticist.

“If the patient is mutation positive, there is evidence of them being more beneficial to chemotherapy, as they are more at risk of a secondary cancer.”

If disease is detected early enough, exposure to toxins in chemotherapy or hormone therapy can be reduced, thus extending the woman’s fertility window after treatment.

“I strongly believe tests on fertility issues should be done by the medical oncologist before treatment commences,” said Dr Fedro Peccatori, from the European School of Oncology in Milan.

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