Thursday, 12 November 2015

Conference Monday

It has been rather a busy week, but at last I'm getting round to updating on last week's NCRI cancer conference!

My Conference Monday started with a workshop giving an update on the Genomics England 100, 000 genome project and associated work.  One of the important messages was the need for the pathology methods which support tissue collection and Louise Jones presented the pilot work in delivering the necessary protocols.  This is clearly a challenging area but clear progress is being made.  Many of the GeCIP leads were on the workshop panel and spoke of the progress and challenges in their areas.  An interesting question posed was 'what if the pathology goes on to suggest treatment that is not in the guidelines?'  All in all it was an exciting start to the day, with many issues still to be resolved.

It was a busy day, with some interesting plenaries in addition to the symposia and parallel sessions.  I spent quite a bit of it in sessions looking at risk, screening and early diagnosis in various cancers but particularly ovarian. In the morning I was at Molecular Testing for Early Cancer Diagnosis and in the afternoon it was Screening and Epidemiology of Ovarian Cancer.

In the morning Marc Tischkowitz reviewed lessons from the GTEOC (genetic testing in epithelial ovarian cancer) study, which recruited women newly diagnosed with epithelial ovarian cancer for BRCA 1/2 testing.  With cheaper and faster testing now available, there are issues around who should be offered testing and what support and counselling should be given.  Traditionally in the UK, genetic testing for hereditary cancers has been available to a fairly limited pool of people and only with genetic counselling and support (sometimes quite extensive).   If the numbers being testing increase considerably, the genetic counselling services will be overwhelmed.  In the GTEOC study the mean age of the participants at diagnosis was 65, with a 7% mutation yield.  However that 7% was not spread evenly throughout the age range, with those under 70 years (not exactly surprisingly) being much more likely to carry a mutation than those 70 and over.  The  pyschosocial arm of the study suggested that a lack of intensive genetic counselling prior to testing was not detrimental and suggests that wider testing at around the time of diagnosis would be acceptable, especially given that the current family history criteria will always miss people in whom mutations would be found if this whole group of newly diagnosed women was offered testing.

This presentation was followed by Peter Sasieni, looking at molecular biomarkers.  As well as the biomarker considerations, he raised some interesting issues for risk testing at a whole population level, pointing out that identifying those at high risk did not equal early diagnosis.   Moreover, identifying genetic predispositions could label millions of people (with attendant difficulties) while not offering intervention to most of those who will actually develop cancer. In addition, there is always a risk that knowledge of low risk could encourage risky behaviours!  For those of us who see risk and screening through the prism of a cancer diagnosis, this was a timely reminder of the general population situation.

Moving onto the afternoon parallel session I attended, three papers particularly struck me.  The first was  by Ranjit Manchanda looking at population based screening.  The pollution concerned in this study was the Ashkenazi-Jewish population comparing population screening for founder mutations with the traditional family history based method.  Included in this study was the use of a dvd based approach to delivering information about risk and counselling.  This method proved to be both acceptable and non-inferior and was supported by telephone counselling for high risk women.  It was concluded that modern methods mean  population stratification and panel testing is both acceptable and cost-effective.

The next paper was by Kezia Gaitskell and considered the association of child bearing patterns and ovarian cancer, concluding that histological type made a considerable difference.  When there was an association, childbearing conferred an overall 26% lower risk in those women in the study, with each birth lowering risk.  This study used data from the Million Women Study.

Valerie Beral then looked at factors that might raise or reduce risk of ovarian cancer, using data from around 50 studies and 25, 000 cases.  Perhaps the most striking was her conclusion that 15 years of use of the oral contraceptive pill halves the risk of ovarian cancer and that this benefit persists.  Use of HRT raises the risk of ovarian cancer  as well as breast cancer but, at least in the case of ovarian, that risk does not persist at the same level after use has stopped.

After that, it was off to a meeting relating to another study and then the Consumer Forum meeting, before a dinner to celebrate a couple of birthdays.

A Very Full Day!   

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