Relative Risk: Breast Cancer and Genetics

Progress Educational Trust
Darwin Lecture Theatre, Darwin Building, University College London, Malet Place, London WC1E 6BT
3 April 2014 6.30pm-8.30pm
This public event was organised by the Progress Educational Trust (PET) at University College London, and was supported by the Wellcome Trust. The event marked the launch of the PET project 'Breast Cancer: Chances' (which continued with the succeeding events 'Risk Assessment: Breast Cancer', 'Risk Management: Breast Cancer, Business and Patents' and 'Breast Cancer Risk: Facts, Fictions and the Future').
A podcast produced by James Brooks, in which he interviews members of the speaker panel, can be listened to using the player below or alternatively can be downloaded by clicking here (.mp3 17.6MB).
Matthew Thomas has written a summary of this event for PET's flagship publication BioNews, and James Heather has written a summary of this event for the Wellcome Trust's blog. Panel speaker Kerry Andrew discusses the themes of the event in her BioNews article 'BRCA and I', while journalist and filmmaker Tessa Mayes quotes several of the panel speakers here.
When the actress Angelina Jolie wrote publicly about her decision to undergo a prophylactic double mastectomy, breast cancer captured the world's attention. Jolie opted for the procedure because of the breast cancer risk posed by a BRCA1 gene mutation she carries, and the fact that her mother and grandmother died from cancer. Jolie is still being widely praised for having promoted awareness and understanding of breast cancer, but her case raises two questions. First, to what extent was her situation representative - either of women in general, or of people who are predisposed to develop breast cancer? Second, to what extent was her response to her situation proportionate?
Breast cancer is a common form of cancer in women (and a rare form of cancer in men), but only a small minority of cases are thought to be caused by highly penetrant inherited mutations in a single gene. More than half of these cases are caused by mutations in the BRCA1 or BRCA2 genes, which also greatly increase the risk of ovarian cancer. BRCA genes aren't the whole story, however - nine non-BRCA genes linked to breast cancer are currently being tested for as part of the Mainstreaming Cancer Genetics programme, and an inherited predisposition to breast cancer may involve many genes rather than just one. Genetics may also affect people's responsiveness to breast cancer prevention and treatment, thereby opening up possibilities for tailoring prevention and treatment to individuals or groups (personalised medicine).
Counselling is available to women deciding what - if anything - to do if they are at increased risk of breast cancer. Mastectomy (removal of one or both breasts) and oophorectomy (removal of one or both ovaries) are two drastic preventative options, among several options that are available to patients in a similar predicament to Jolie. Among the less drastic options is one that has been recommended by the National Institute for Health and Care Excellence - that healthy women over 35 at high risk of breast cancer should be offered preventative drug therapy, something that has not happened previously outside of clinical trials.
This event saw these and other aspects of breast cancer discussed in relation to genetics and risk, from contrasting perspectives, by a panel of experts.

Kerry Andrew
Patient and carrier of a BRCA1 gene mutation
Diana Eccles
Professor of Cancer Genetics and Director of the Clinical Trials Unit at the University of Southampton
Gareth Evans
Professor of Medical Genetics and Cancer Epidemiology at the University of Manchester, and Consultant in Medical Genetics and Cancer Epidemiology at the Christie and Central Manchester University Hospitals NHS Foundation Trusts
Baroness Delyth Morgan
Crossbench Peer in the House of Lords, Chief Executive of Breast Cancer Campaign and former Chief Executive of Breakthrough Breast Cancer
Gordon Wishart
Consultant Breast and Endocrine Surgeon, Visiting Professor of Cancer Surgery at Anglia Ruskin University and former Director of the Cambridge Breast Unit at Addenbrooke's Hospital

Dr Christine Patch
Consultant Genetic Counsellor and Manager at Guy's and St Thomas' NHS Foundation Trust, and former Chair of the British Society for Genetic Medicine

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  Wellcome Trust