Targeted screening could improve fertility in breast cancer survivors
Oncologists say insurers should cover cost of blood tests that would help identify risk
More breast cancer patients could start families if there were a better targeted, preventive approach to screening that allowed earlier diagnoses and the most effective treatment.
Chemotherapy and hormone therapy can have devastating physical effects, despite their success in killing cancer.
Women are advised not to start a family until at least a year after chemotherapy has ended, while hormone therapy can continue for more than a decade.
A simple blood test for the BRCA 1 and 2 genes, known precursors to breast cancer, could help to 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, an oncologist at City Hospital in Dubai, told the European Association for Cancer Research in Madrid: “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 and 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 is more at risk. These are the people we should be trying to screen for the BRCA 1 or 2 genes 10 years or so before their relatives had breast cancer.”
A BRCA screen is a simple blood test that costs about Dh6,000.
Although not practical for every woman, Dr Al Khatib recommends those with a family history should be a priority because early detection could save thousands of dirhams for each case of breast cancer.
Surgery can cost between Dh50,000 and Dh60,000, while radiotherapy costs about Dh100,000 and an average chemotherapy course can be Dh400,000.
If the woman needs other hormonal treatments, costs can exceed Dh1 million.
“We can then go on to detect their other family members through a test,” Dr Al Khatib said.
“It would be the most effective option to reduce the cost of cancer treatments.
“Surgery would give 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 after they have recovered.
Fertility and breast cancer treatments were discussed by other specialists at the summit. They told of recent research showing that gene expression tests could be done to help determine appropriate treatment.
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 drugs were markedly more toxic than others and could damage fertility.
The age of the woman should determine whether she was 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 information from a patient to help give doctors data on which to base a decision on the most suitable form of treatment.
The National Cancer Institute of Spain says about 12 per cent of women in the 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 the age of 70. They are also more susceptible to ovarian cancer.
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 as to whether to refer a patient for genetic testing, not only for BRCA 1 or 2 but also for other indicators,” Dr Delalogue 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 chemo or hormone therapy can be reduced, 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.
Surgery would give 100 per cent protection but there are other drug treatments that can offer 90 per cent protection DR FALAH AL KHATIB Oncologist, City Hospital, Dubai