Clinical services must catch up

October 19, 2002

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Despite the immense potential impact of the Human Genome Project on clinical care, there are almost no clinical services available to cope with the demand, warned a London geneticist at a European cancer congress. More genetic components, linked to different types of cancers, will be identified in the near future and this will place an ever-increasing workload on those who provide screening and diagnostic services and therapy.

Speaking today (19 October 2002) at the European Society for Medical Oncology Congress in Nice, France, Dr James Mackay from the Institute of Child Health, London, described how new genetic information will influence clinical management of inherited cancers. "Already, genetic information is important for those at risk of developing some cancers. Soon, it could be important in the care of cancer patients - we would be tailoring therapies to individuals according to their genetic make-up," he said.

Taking as an example the genes BRCA1 and BRCA2, that are associated with breast cancer, Dr Mackay said that the rate of detection of mutations of these genes is poor in many European countries, including the UK, partly because the tests to determine the risk based on family history are inadequate. Dr Mackay believes, however, that the technical difficulties are likely to be overcome in the next few years, although new services to cope with the increasing workload will have to be implemented.

Dr Mackay works with families with an inherited risk of disease and investigates ways to improve methods to prevent, screen and diagnose cancer. "To a large extent, genetics is based on uncertainty and people don't like uncertainty. However, if you take the time to explain why you can't give them a definite answer, people understand the concept of inherited risk."

Some clinicians, he has found, are also sceptical about the role of genetic information in the management of disease. "To spend your working life talking to patients about their risk is quite different to treating a patient with a specific condition and, therefore, requires a different attitude altogether," said Dr Mackay.

In London, a new Genetics Knowledge Park will help to address the problem of a lack of genetic services. The 'park', which started in June this year, is not situated in a building or an institution but is a collaboration of expertise: a virtual centre of excellence in genetic research and application. Dr Mackay will be one of a team who will develop training programmes for healthcare professionals and clinical services to patients.

Tele-medicine is another potential opportunity to maximise limited resources. Dr Mackay has been exploring the feasibility of consultations via live television links with families at high-risk of developing cancer. "The patient, in the presence of a nurse, would talk to the doctor down the line," he explained. "Doctors will need to learn new skills for this type of interaction, but it means the patient has rapid access to a specialist in the field, without having to go anywhere."

"The potential explosion of knowledge is absolutely massive yet we are still unprepared to take it into clinical care," he concluded.

European Society for Medical Oncology

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