Question to the Minister of Health

ANSWER

For a summary of the options available to women at high risk of breast cancer

If a woman thinks she may be at high risk of breast cancer due to family history she can access information on eligibility for genetic testing on the Genetic Medicine Website. All NI Trusts have Breast Family History resources available on their websites, these are also available on the Northern Ireland Cancer Network website. Breast family history resources

I Northern Ireland Cancer Network (hscni.net)

For women and families where there is a known inherited genetic change in a high-risk cancer gene, relatives can either request a referral from their GP or self-refer to the Cancer Genetics service to discuss genetic testing. The service offers cascade family testing to blood relatives of the index patient to identify those family members who have inherited the variant and are at a higher risk of developing breast, ovarian, and other cancers. This enables the establishment of preventive and surveillance measures such as risk-reducing mastectomy or chemo prevention treatment.

Family history clinics are embedded within the breast service of each trust. A patient may also be referred by their GP to a family history clinic for assessment due to family history of breast cancer. Family history clinics identify women who may be eligible for genetic testing or may benefit from a further assessment with the Cancer Genetics Service. Chemo prevention drugs are discussed with all patients at family history clinics in line with National Institute for Health & Care Excellence (NICE) guidance. Where appropriate patients with familial / genetic risk will be offered risk reduction surgery in all Trusts to reduce the risk of breast cancer. All Trusts have Breast Family History resources available on their websites, they are also available on the Northern Ireland Cancer Network website. Breast

family history resources I Northern Ireland Cancer Network (hscni.net)

Whether there will be an expansion of screening programs to enable earlier and more frequent access to those with genetic predispositions or other elevated risk factors

Women at very high risk of breast cancer are currently offered breast screening annually and at an earlier age than the routine Breast Screening Programme for the general population. This surveillance screening for women at very high risk (VHR) of developing breast cancer was introduced in Northern Ireland in 2013 and is carried out at a Specialist Imaging Unit in Antrim Area Hospital.

Women identified as being at very high risk (8 times greater relative risk compared to women in the general population) of developing breast cancer are referred into the programme, following an assessment by a specialist in genetics or oncology confirming one of the following genetic mutations: BRCAI,  BRCA2,  TP53, A-T  homozygotes,  PALB2,  PTEN,  STKl 1, CDH1, or another genetic mutation with a similar level of risk; or because they have had radiotherapy treatment to an area involving breast tissue.

Women at very high risk are invited for annual MRI, mammography, or both depending on their age and the reason for their referral. Tests and frequency of testing for these women in Northern Ireland is in line with the NHS England Breast Screening Programme Protocols for the surveillance of women at higher risk of developing breast cancer.

A Public Health Agency leaflet 'Breast surveillance screening for women with a very high risk of breast cancer', is publicly available and it explains the breast surveillance screening programme for these women in Northern Ireland.

There are no plans to further expand the very high-risk breast screening programme.