The Angelina effect - How Hollywood star’s double mastectomy caused big rise in referrals to family history breast clinic at the N&N
06:30 30 August 2014
When Angelina Jolie told the world she had undergone a double mastectomy to reduce her risk of breast cancer, many women started looking at the prevalence of the disease in their own families.
More emotional support for breast cancer patients
A hospital is offering more psychological and emotional support to women after they are given the news that they have breast cancer.
The Norfolk and Norwich University Hospital has a team of breast care nurse specialists who are assigned to new patients to provide them the support and information they need to help them get through their treatment.
The nurses are also available to speak to patients over the phone, if they have particular questions or concerns.
Joann McGrath, lead breast care nurse at the N&N, said the team saw 600 breast cancer patients last year and their caseload was going up every year.
She added that they could also refer patients to a psychologist or a psychological therapist, employed by the NHS trust, if they needed extra emotional support.
“In the UK, 55,000 people are diagnosed with breast cancer each year and we are seeing so many cases because people are more breast aware and the breast screening programme has been lowered to 47 onwards and those two factors have impacted on how many ladies we are seeing.”
“Patients are surviving longer following a cancer diagnosis and we have an obligation to support patients to live a healthy and active life for as long as possible. Because we are picking up ladies at a much earlier stage of the disease, our survivor rates are getting better and patients are living longer and disease free for longer,” she said.
The Hollywood actress, whose mother had died of ovarian cancer aged just 56, found out she carried a ‘faulty’ BRCA1 gene, which greatly increased her risk of both breast and ovarian cancer.
Following new guidelines on genetic testing by the National Institute of Clinical Excellence (NICE) and Jolie’s revelations, referrals to the Family History Breast Clinic at the Norfolk and Norwich University Hospital trebled, to a level that, according to specialist breast physician Dr Carole Wyatt “was quite difficult to deal with”.
She thought they would see women worrying unnecessarily, but the number of BRCA 1 detections rose –they had genuine cause for concern.
“It’s important to understand that most breast cancer is not genetic – 80 to 90pc is nothing to do with inherited factors at all,” said Dr Wyatt.
“It’s the most common cancer in the UK, about one in eight of us is going to get it at some point. We know that about 10pc of breast cancer has an inherited cause and about half of those are caused by BRCA 1 or 2 genes. The other half are genetic in some way, but we don’t have the science yet. It’s not black and white, it’s a very complicated area.”
The first thing the clinic does is draw up a family tree with patients to work out who has had cancer and at what age.
They look for relatives diagnosed at a young age (under 40) and a family with more cases than would be expected by chance.
Dr Wyatt said they look for cancer coming down through generations on one side of the family or the other – in people who are blood relations.
Ovarian cancer can be linked as well.
“We would look at regular mammograms or, in certain cases, we would refer to the clinical testing team for genetic tests,” she said.
“BRCA 1 is more aggressive and is more difficult to detect on mammograms. It can just pop up from nowhere. BRCA 2 is in a slightly older woman and is slightly easier to pick up on mammograms. Early detection is key.”
A risk-reducing drug has been recommended for use for the first time by NICE.
But Dr Wyatt said the evidence was a “bit patchy” and the drug came with a number of side effects, including weight gain, thinning hair, a lack of sex drive and a small risk of womb cancer in older women.
She is keen to stress the importance of lifestyle choices, with exercise being powerfully protective against cancer and alcohol a strong risk factor.
“Even a couple of glasses throughout the week can increase the risk,” said Dr Wyatt.
“These are lifestyle things that have become so normal, we have come to accept them. But we are not made to drink alcohol like that.”
If genetic testing is carried out and a ‘faulty’ BRCA gene is detected, people have two options.
They can either keep in regular contact with the Family History Breast Clinic and have more frequent mammograms or they can opt for surgery –- a double mastectomy and possibly having their ovaries removed because of the risk of ovarian cancer.
People are supported all the way through and any surgery can be carried out at the Norfolk and Norwich University Hospital.
“The bottom line must be ‘watch this space’,” said Dr Wyatt.
“There is a lot we don’t know and a huge amount of work still to be done.”
If you are concerned about BRCA 1 or 2 in your family, visit your GP who can refer you to a clinic.
There is more information about the genes at www.breastcancercare.org.uk
Has your family been affected by breast cancer? Contact health correspondent Adam Gretton by emailing firstname.lastname@example.org