Integration of Genetics into Breast Cancer Management in South Africa
Breast cancer, one of the leading causes of death amongst females of all population groups (estimated 375 000 deaths in 2000), is due to its complexity often under managed with dire consequences. Globally, several attempts have been made to enable earlier diagnosis, increasing survival rate and improving patient management minimising risk and anxiety to the patient and their family members. Genecare Molecular Genetics, a molecular biology company has approached the complex problem of breast cancer by forming a multidisciplinary team consisting of physicians, medical geneticists, genetic counsellors, oncologists and surgeons who collaborate in the patient’s management. The latest molecular technology and scientific research form the basis of the genetic service offered to the patient and the health care provider. In the pre-test counselling the multidisciplinary team advises the patient as to which genetic tests are relevant to their situation. These could include genetic tests for susceptibility genes (e.g. BRCA1/2 full gene analysis), tumour suppressor genes (TP53 full gene analysis), pharmacological pathway genes (e.g. DPD, Her2/neu) and/or a 70 gene prognostic test. The latter aids physicians to determine relevant treatment protocols and possible patient outcomes. Post-test counselling ensures the efficient management of the patient’s expectations. Several new techniques and methodologies have been incorporated to make these genetic tests cost effective for the patient with enhanced benefits to medical insurers. Genecare Molecular Genetics has adapted this approach and applied it to other cancers (e.g. colorectal) and complex diseases (e.g. metabolic disorders) in order to widen the scope of the molecular services offered.