My Working Day: Victoria Lee is clinical nurse manager for the family risk assessment clinic in breast care in Tallaght Hospital, Dublin, which has 350 women on its books
The family risk assessment clinic in breast care at Tallaght Hospital was set up in October 2004 with the aim of identifying women who may be at increased risk of developing breast cancer because of family history. I'm the clinical nurse manager at the clinic and I work with consultant breast surgeons Mr James Geraghty and Ms Jane Rothwell.
Primarily, we see women who do not have symptoms of breast cancer but who have a strong history of breast cancer in their families. The aim is to assess how big their risk of developing breast cancer is and to develop an appropriate management plan which will primarily involve screening.
When it comes to family history, the main consideration is the age a relative was diagnosed with breast cancer. Other considerations include the number of relations diagnosed, the number of generations affected, whether these relatives had cancer in both breasts, whether there is a history of ovarian cancer and whether there is a history of male breast cancer.
Once a client is referred to me I will look at their history and decide if they are at high, medium or low risk.
A major part of the assessment is getting clients to research their family histories on both the maternal and paternal side for three generations. Once the client has done the research, I will meet her and draw up a family tree. It is a very visual educational tool. She will be able to see cancer coming down her family tree. After the assessment I will meet Mr Geraghty and he will make the final decision on how frequently the client needs to be screened.
A woman is usually classed as medium risk if she has two first or second degree relatives (mother, sister or aunt) who have been diagnosed with breast cancer over the age of 50. If these relations were under 50 when they were diagnosed, the woman is classed as high risk. The woman will then get a clinical and radiological examination every six-18 months, depending on what risk group they are in.
At the clinic we are dealing with people from our own catchment area - Kildare, Wicklow, south Dublin and Carlow. But if a woman or a GP phones me and they are concerned about a family history, I will see her.
We are the first family risk assessment clinic established with a specific breast service. Prior to this, GPs had nowhere to send women concerned about their family history aside from referring them for genetic testing. The clinic runs three days a week and there is a huge demand for the service with around 350 medium to high risk women on our books. More than 100 have been seen to date.
Further information about the family risk of breast cancer is available from the Irish Cancer Society (www.cancer.ie or 1800-309040) or from the family risk assessment clinic in breast care in Tallaght Hospital (01-4144277).
(In conversation with Fiona Tyrrell)